Chewing Gum: A Funny Way Opposed To Postoperative Ileus For Gynecological Operations

Abstract

Aim: The purpose of this study was to evaluate whether sugarless gum chewing promotes recovery of bowel function after total abdominal hysterectomy and bilateral salphingooferectomy. Also post operative analgesic and anti-emetic requirement were assessed.Material and Methods: 98 patients were enrolled into the study; 54 55.1% patients in the study gumchewing group and 44 44.9% cases in the control group. Patients in the gum chewing group chewed gum six times per day during post operative period and were asked to chew gum at least half an hour each time. The outcomes of the study were time to first flatus, first bowel movement, duration of hospitalization and need of analgesics and/or antiemetics during postoperative period.Results: Median flatus time was 7 hours in the gum chewing group and 9 hours in the control group. There was statistically significant difference between two groups in terms of time to flatus. Bowel sounds appeared significiantly earlier in the study group. At postoperative eighth hour, bowel sounds were active in 53 98.1% cases in the study group, and 23 52.3% cases in the control group.Conclusion: Gum chewing following gynecological operations offers significant benefits in reducing the time to resolution of bowel functions. It is a simple, inexpensive, convenient, and physiological method for enhancing the recovery of bowel function.

Keywords

• Postoperative ileus,gum chewing,surgery

Jinekolojik Operasyonlarda Postoperatif İleusu Önlemek İçin Tuhaf Bir Yol: Sakız Çiğneme

Abstract

Amaç: Bu çalışmanın amacı sakız çiğnemenin total abdominal histerektomive bilateral salpingo- ooferektomi ameliyatından sonra bağırsak fonksiyonlarının geri dönüşünde etkisi olup olmadığının değerlendirilmesidir. Ayrıca postoperatif ve analjezik ve antiemetik ihtiyacı da değerlendirildi.Gereç ve Yöntemler: Çalışmaya 98 hasta katıldı; çalışma grubunda sakız çiğneyen 54 %55.1 hasta, kontrol grubunda sakız çiğnemeyen 44 %44.9 hasta mevcuttu.Çalışma grubuna ameliyat sonrası günde 6 kez ve her seferinde en az yarım saat sakız çiğnemeleri söylendi. Ameliyat sonrası dönemde gaz çıkarana kadar geçen süre, ilk barsak hareketleri oluşana kadar geçen süre, hastaların analjezik ve antiemetik ihtiyaçları ve hastanede kalış süreleri değerlendirildi.Bulgular: Sakız çiğneyen grupta gaz çıkarana kadar geçen süre ortalama 7 saat, kontrol grubunda ortalama 9 saat olarak bulunmuştur, iki grup arasında gaz çıkarma sürelerinde anlamlı farklılık saptanmıştır. Bağırsak seslerinin tespit edilmesi sakız çiğneyen grupta kontrol grubuna göre daha erken olmuştur. Çalışma grubunda postoperative 8.saatte 53 %98.1 hastada bağırsak sesleri aktifken, kontrol grubunda bu sayı 23 %52.3 olarak bulundu.Sonuç: Jinekolojik operasyonlardan sonra sakız çiğnemenin bağırsak fonksiyonlarının geri dönüş süresini kısaltmak konusunda anlamlı etkisi mevcuttur. Sakız çiğnenmesi bağırsak fonksiyonlarının iyileştirilmesinde basit, ucuz ve güvenle uygulanabilecek fizyolojiye uygun bir yöntemdir.

Keywords

• Postoperatif ileus,sakız ciğneme,cerrahi

References

1. Behm B, Stollman N. In: Practical Gastroenterology. Westhampton Beach, NY: Shugar Publishing Inc; 2002. Postoperative ileus; 13–24.
2. Yuan CS, Foss JF, O’Connor M, Toledano A, Roizen MF, Moss J. Methylnaltrexone prevents morphine-induced delay in oral-cecal transit time without affecting analgesia: A double-blind randomized placebo- controlled trial. Clin Pharmacol Ther 1996; 59: 469–75.
3. Kalff JC, Schraut WH, Simmons RL, Bauer AJ. Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus. Ann Surg 1998; 228: 652–63.
4. Crainic C, Erickson K, Gardner J, Haberman S, Patten P, Thomas P, Hays V. Comparison of methods to facilitate postoperative bowel function. Medsurg Nurs 2009; 18: 235-8.
5. Asao T, Kuwano H, Nakamura J, Morinaga N, Hirayama I, Ide M. Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. J Am Coll Surg 2002; 195: 30–2.
6. Tandeter H. Hypothesis: Hexitols in chewing gum may play a role in reducing postoperative ileus. Med Hypotheses 2009; 72: 39–40.
7. Oku T, Nakamura S. Threshold for transitory diarrhea induced by ingestion of xylitol and lactitol in young male and female adults. J Nutr Sci Vitaminol (Tokyo) 2007; 53:13-20.
8. Sanjay Marwah, Sham Singla, and Pradeep TinnaRole of Gum Chewing on the Duration of Postoperative Ileus Following Ileostomy Closure Done for Typhoid Ileal Perforation: A Prospective Randomized Trial Saudi J Gastroenterol 2012; 18: 111–117.

9. Abd-El-Maeboud KH, Ibrahim MI, Shalaby DA, Fikry MF. Gum chewing stimulates early return of bowel motility after caesarean section 2009; 116: 1334-9.
10. Holte K, Kehlet H. Postoperative ileus: a preventable event. Br J Surg 2000; 87: 1480- 1493.
11. Lubawski J, Saclarides T. Postoperative ileus: strategies for reduction. Ther Clin Risk Manag 2008; 4: 913–917.
12. Kalff JC, Schraut WH, Billiar TR, Simmons RL, Bauer AJ. Role of inducible nitric oxide synthase in postoperative intestinal smooth muscle dysfunction in rodents. Gastroenterology 2000; 118: 316–327.
13. Kalff JC, Schraut WH, Simmons RL, Bauer AJ. Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus. Ann Surg 1998; 228:652–663.
14. Aybala Agac Ay, Suat Kutun, Haluk Ulucanlar, Oguz Tarcan, Abdullah Demir, Abdullah Cetin. Risk factors for postoperative ileus J Korean Surg Soc 2011; 81: 242–249.
15. Cali RL, Meade PG, Swanson MS, Freeman C. Effect of Morphine and incision length on bowel function after colectomy. Dis Colon Rectum 2000; 43:163–168.
16. Asao T, Kuwano H, Nakamura J, Morinaga N, Hirayama I, Ide M. Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. J Am Coll Surg 2002; 195: 30- 32
17. de Castro SM, van den Esschert JW, van Heek NT, Dalhuisen S, Koelemay MJ, Busch OR, Gouma DJ. A systematic review of the efficacy of gum chewing for the amelioration of postoperative ileus. Dig Surg 2008; 25: 39-45.
18. Noble EJ, Harris R, Hosie KB, Thomas S, Lewis SJ. Gum chewing reduces postoperative ileus? A systematic review and meta-analysis. Int J Surg 2009; 7: 100-5
19. Abd-El-Maeboud KH, Ibrahim MI, Shalaby DA, Fikry MF. Gum chewing stimulates early return of bowel motility after caesarean section. BJOG 2009; 116: 1334-9.
20. Kafali H, Duvan CI, Gözdemir E, Simavli S, Onaran Y, Keskin E. Influence of gum chewing on postoperative bowel activity after cesarean section. Gynecol Obstet Invest 2010; 69:84-7.