Usefulness of Gum Chewing to Decrease Postoperative Ileus in Colorectal Surgery with Primary Anastomosis: A Randomized Controlled Trial.

BACKGROUND: Postoperative ileus generates a high impact on morbidity, hospital stay, and costs. OBJECTIVE: To study the efficiency and safety of chewing gum to decrease postoperative ileus in colorectal surgery. METHOD: A randomized controlled trial was performed including 64 patients who underwent elective colorectal surgery with primary anastomosis in a tertiary referral center. Patients were divided in two groups: (i) A: gum chewing group (n = 32), and (ii) B: patients who had standard postoperative recovery (n = 32). RESULTS: Postoperative ileus was observed in 6% (2/32) of the gum-chewing group and in 21.8% (7/32) in the standard postoperative recovery group, with an odds ratio of 0.167 (95% CI: 0.37-0.75; p = 0.006). Vomiting was present in two patients from group A and in eight from group B (6.25 vs. 25.0%; p = 0.03). Passage of flatus within the first 48 hours was present in 30 patients from group A and in 20 from group B (94 vs. 63%; p = 0.002). There was earlier oral feeding (96 ± 53 vs. 117 ± 65 hours; p= 0.164) and a shorter length of hospital stay (7 ± 5 vs. 9 ± 5 days; p= 0.26) in the gum-chewing group (p N.S.). CONCLUSIONS: The use of chewing gum after colorectal surgery was associated with less postoperative ileus and vomiting, and with an increased passage of flatus within the first 48 hours after surgery. Since gum chewing is an inexpensive procedure and is not associated with higher morbidity, it can be safely used for a faster postoperative recovery in elective colorectal surgery.