The Efficacy of Chewing Gum in Postoperative Ileus Management After Robot Assisted Laparoscopic Radical Prostatectomy: A Prospective Randomized Study

Yıl 2020, Cilt: 10 Sayı: 1, 96 - 101, 31.03.2020

İbrahim Karabulut , Ali Haydar Yılmaz , Fatih Yılmazel

https://doi.org/10.16899/jcm.656495

Öz

Aim:To examine the efficacy of chewing gum on bowel motility in the early postoperative period in patients with prostate cancer undergoing robot-assisted laparoscopic prostatectomy (RALP) we prepared this study.
Materials and Methods:The study was obtained from the local ethics committee. A total of 67 patients who underwent general anaesthesia were included in the study. Patients were divided into two groups as chewing gum group (Group G) and the control group (Group C). In the postoperative period, the patients in the Group G were chewed gum in the postoperative period. Bowel function improvement was inspected. The study was terminated at the first gas passage occurred. This time interval was noted. Demographic datas, intraoperative parameters, surgical results were analysed and compared. The first time of bowel movement, length of hospitalisation, and surgical wound site pain and abdominal pain intensity according to the Visual Analogue Scale (VAS) were recorded at the 12th 24th and 36th postoperative hours.
Results:At the end of the study, 23 patients in the Group C and 25 patients in Group G were evaluated. There was no significant difference in demographic datas between the groups. No statistically significant difference was observed in all intraoperative parameters. First bowel movements and postoperative abdominal and surgical wound site pain at the 24th and 36th hours were significantly lower in Group G compared to Group C.
Conclusions:This study indicated that chewing gum is also efficient in early solution of postoperative ileus.

Anahtar Kelimeler

Chewing Gum, , Prostate Cancer, , Paralitic İleus, , Robotic Surgery

Robot Yardımlı Laparoskopik Radikal Prostatektomi Sonrası Oluşan Fizyolojik İleus Yönetiminde Sakız Çiğnemenin Etkinliği

Öz

Amaç: Major ürolojik cerrahi sonrası görülen ileus, hasta iyileşmesini geciktirebilir . Biz bu çalışmamızda kliniğimizde prostat kanseri nedeni ile robot yardımlı laparoskopik prostatektomi (RALP) uygulanan hastalarda postoperatif erken dönemde sakız çiğnemenin bağırsak hareketliliği üzerindeki etkinliğinin araştırılmasını amaçladık.
Gereç ve Yöntem: Çalışma öncesi yerel etik kuruldan onam alındı. Çalışmaya toplam 67 hasta dahil edildi. Hastalar rastgele kontrol grubu (Grup C) ve çalışma grubu (Grup G) olarak iki gruba ayrıldı. Çalışma grubunda ki hastalara postoperatif dönemde sakız çiğnetildi. Bağırsak fonksiyon iyileşmesi incelendi. Çalışma ilk gaz geçişinde sonlandırıldı. Bu zaman aralığı kaydedildi. Demografik veriler, intraoperatif parametreler, cerrahi sonuçlar analiz edildi ve karşılaştırıldı. Ameliyat sonrası 12. ve 24. saatlerde barsak hareketinin ilk zamanı, hastanede kalış süresi ve cerrahi yara bölgesi ağrısı ve karın ağrısı kaydedildi.
Bulgular: Çalışma grubundaki hastaların yaş ortalaması 60,56 ± 6,07 yıl, kontrol grubundaki hastaların ise 60.26 ± 6.87 yıl olarak ölçüldü. Çalışmanın sonunda grup C de 23 hasta, grup G de 25 hasta değerlendirildi. Gruplar arasında demografik verilerde anlamlı fark yoktu. Perioperatif parametrelerde her iki grup arasında anlamlı bir fark gözlemlenmedi. İlk bağırsak hareketleri , postoperatif karın ve yara bölgesi ağrısı 24. ve 36. saatler de grup G lehine anlamlı derecede istatistiksel fark tespit edildi.
Sonuç: Bu çalışma sakız çiğnemenin postoperatif ileusun erken dönemde çözümlenmesinde etkili olduğunu göstermiştir.

Anahtar Kelimeler

Sakız, prostat kanseri, Paralitik İleus, Robotik Cerrahi

Kaynakça

• 1-Livingston EH, Passaro EP. Postoperative ileus. Dig Dis Sci 1990; 35.121-32.
• 2-Shibata Y, Toyoda S, Miyati M, et al. Patterns of intestinal motility recovery during the early stage following abdominal surgery: clinical and manometric study. World J Surg. 1997; 21: 806-809.
• 3-Lee H, Cho CW, Yoon S, et al. Effect of sham feeding with gum chewing on postoperative ileus after liver transplantation — a randomized controlled trial. Clin Transplant 2016; 30: 1501-7.
• 4-Matros E, Rocha F, Zinner M, et al. Does gum chewing ameliorate postoperative ileus? Results of a prospective, randomized, placebo controlled trial. J Am Coll Surg 2006; 202: 773-8.
• 5-Choi H, Kang SH, Yoon DK, et al. Chewing gum has a stimulatory effect on bowel motility in patients after open or robotic radical cystectomy for bladder cancer: a prospective randomized comparative study. Urology 2011; 77: 884–90.
• 6-Asgeirsson T, El-Badawi KI, Mahmood A, et al. Postoperative ileus: it costs more than you expect. J Am Coll Surg 2010; 210: 228–31.
• 7-Noble EJ, Harris R, Hosie KB, et al. Gum chewing reduces postoperative ileus? A systematic review and meta-analysis. Int J Surg 2009; 7: 100-5.
• 8-Bisanz A, Palmer JL, Reddy S, et al. Characterizing postoperative paralytic ileus as evidence for future research and clinical practice. Gastroenterol Nurs 2007; 31: 336–44.
• 9-Holte K, Kehlet H. Postoperative ileus: a preventable event. Br J Surg 2000; 87: 1480-93.
• 10-Heidenreich A, Bellmunt J, Bolla M et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis and treatment of clinically localised disease. Eur Urol 2011; 59: 61–71.
• 11-Leow JJ, Chang SL, Meyer CP et al. Robot-assisted versus open radical prostatectomy: a contemporary analysis of an all-payer discharge database. Eur Urol 2016; 70: 837–45
• 12-Stolzenburg JU, Kyriazis I, Fahlenbrach C et al. National trends and differences in morbidity among surgical approaches for radical prostatectomy in Germany. World J Urol 2016; 34: 1515–20
• 13-Yaxley JW, Coughlin GD, Chambers SK et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet 2016; 388: 1057–66
• 14-Kouba EJ, Wallen EM, Pruthi RS, et al. Gum chewing stimulates bowel motility in patients undergoing radical cystectomy with urinary diversion. Urology 2007; 70: 1053-6.
• 15-Maffezzini M, Campodonico F, Parodi D, et al. Current perioperative management of radical cystectomy with intestinal urinary reconstruction for muscle-invasive bladder cancer and reduction of the incidence of postoperative ileus. Surg Oncol 2008; 17: 41–8.
• 16-Menon M, Hemal AK. Vattikuti Institute prostatectomy: a technique of robotic radical prostatectomy: experience in more than 1000 cases. J Endourol 2004; 18: 611-9.
• 17-Dayton MT, Townsend CM, Beauchamp RD, et al. Sabiston Textbook of Surgery, The Biological Basis of Modern Surgical Practice, 17thed. New York: Elsevier Saunders; 2004.
• 18-Quah HM, Samad A, Neathey AJ, et al. Does gum chewing reduce postoperative ileus following open colectomy for left-sided colon and rectal cancer? A prospective randomized controlled trial. Colorectal Dis. 2006; 8: 64-70.
• 19-Wille-JP, Guenaga KF, Castro AA, et al: pre-operative mechanical bowel cleansing or not? an updated meta-analysis. Colorectal Dis.2005; 7: 304-310.
• 20-Matros E, Rocha F, Whang E, et al. Does gum chewing ameliorate postoperative ileus? Results of a prospective, randomized, placebo controlled trial. J Am Coll Surg. 2006; 202: 773-778.
• 21-Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS (®)) society recommendations. World J Surg 2013; 37: 259–84.
• 22-Nygren J, Thacker J, Carli F, et al. Guidelines for perioperative care in elective rectal / pelvic surgery: enhanced recovery after surgery (ERAS (®)) society recommendations. World J Surg 2013; 37: 285–305.
• 23-Senagore A. Pathogenesis and clinical and economic consequences of postoperative ileus. Clin Exp Gastroenterol 2010; 3: 87–9.
• 24-Saclarides TJ. Current choices good or bad for the proactive management of postoperative ileus: a surgeon's view. J Perianesthesia Nurs 2006; 21: 7–15.
• 25-Asao T, Kuwano H, Nakamura J, et al. Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. J Am Coll Surg. 2002; 195: 30-32.
• 26-Stewart B, Woods RJ, Collopy RJ, et al. Early feeding after elective open colorectal resections: A prospective randomized trial. Aust NZ J Surg. 1998; 68: 125-128.
• 27-Ballantyne JC, Mao J. Opioid therapy for chronic pain. N Engl J Med. 2003; 349: 1943-1953.