The efficacy of chewing gum in reducing paralytic ileus after colorectal surgery

Abstract

Topic Overview: Postoperative ileus is a complication that may result from gastrointestinal surgery and is associated with increased morbidity, extended hospital stays and more expensive treatment. By acting as a form of sham feeding, chewing gum has been proposed to be a simple, inexpensive, non-pharmacological intervention which could promote the return of normal bowel function. The Research Question: Does chewing gum (Intervention) reduce the risk of postoperative paralytic ileus (Outcome) in adult patients who have undergone colorectal surgery? (Population) Method: The inclusion and exclusion criteria were established, and two search engines were used to retrieve studies published within the last five years (2013 onwards). The search captured nine randomised controlled trials, three meta-analyses and a systematic review of overlapping meta-analyses. Critical Analysis: The studies were analysed using the CASP tool and the JBI Checklist. After this process, one RCT was discarded and not included in the discussion of results due to poor rigour. Results: There was discordance in results with most of the RCTs finding no statistically significant difference between the intervention and the control group. However, the meta-analyses retrieved concluded that chewing gum can cause a clinically relevant decrease in postoperative paralytic ileus. In addition, there is also evidence to suggest that there is a reduced benefit if chewing gum is used in conjunction with an ERAS programme. Implications and Recommendations: Recommendations were highlighted including the need for more RCTs utilising an ERAS programme, and for local studies in the area. Should chewing gum be found to be beneficial in these contexts, the introduction of an official Maltese ERAS protocol and the inclusion of gum in this protocol should be considered. It is also recommended that nurses adopt the five stages of the nursing process whilst caring for patients who have been prescribed chewing gum. Conclusion: The various strengths and limitations of this dissertation were highlighted. Given the RCTs obtained, larger and better quality studies are needed to improve the evidence base for use of chewing gum after colorectal surgery.