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Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 82

Chewing gum and postoperative ileus: How to solve a multifactorial problem?

Department of Surgery, Minia University, Al-Minya, El-Minia, Egypt

Date of Web Publication6-Sep-2019

Correspondence Address:
Yasser Ali Kamal
Department of Surgery, Minia University, El-Minya 61519
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ssj.ssj_53_18

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How to cite this article:
Kamal YA. Chewing gum and postoperative ileus: How to solve a multifactorial problem?. Saudi Surg J 2019;7:82

How to cite this URL:
Kamal YA. Chewing gum and postoperative ileus: How to solve a multifactorial problem?. Saudi Surg J [serial online] 2019 [cited 2020 Jul 15];7:82. Available from: http://www.saudisurgj.org/text.asp?2019/7/2/82/266216

Dear Editor,

We read with a great interest the original article by Kalyanwat et al.,[1] who evaluated the role of chewing gum for early recovery of postoperative ileus (POI), but they did not find a significant role of chewing gum in reducing the duration of POI. We thank the authors for their interesting study, but we have additional notes.

Because of the multifactorial nature of POI, the current literature does not provide unique definition, etiology, treatment, or preventive strategy for POI. However, the best chances of reducing POI can be obtained by minimally invasive surgery, early feeding, opioid avoidance, and applying measures to avoid anastomotic leak and other inflammatory consequences.[2]

We think that the small sample size of the study by Kalyanwat et al.[1] could not give an appropriate conclusion, and the authors should include this as a limitation for their study. Moreover, the authors did not consider the data reported in the most recent meta-analyses. To support their findings, they considered only a meta-analysis published in 2015 by Su'a et al.[3] who found a limited clinical significance of chewing gum.

However, the updated meta-analysis by Song et al.[4] in 2016 provides an evidence for the benefit of chewing gum as it enhances the return of gastrointestinal function after colorectal resection with lower risk of POI. Moreover, based on the current evidence in the meta-analysis by Liu et al.[5] published in 2017, chewing gum offers an inexpensive, well-tolerated, safe, and effective method to ameliorate ileus after colorectal surgery; however, tightly controlled, randomized, and considerably larger multicenter trials are recommended to further validate these findings. Accordingly, the evidence for the benefit of chewing gum in reducing the duration of POI remains controversial.

In conclusion, to obtain more conclusive results, further studies are recommended to evaluate the influence of the frequency and duration of gum chewing on the duration of POI. Moreover, the authors of the future studies should consider larger sample size, randomization of the patients for the study and control groups, and adjustment for the perioperative factors that predispose to POI.

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There are no conflicts of interest.

  References Top

Kalyanwat AS, Jakhar M, Jain S. Postoperative ileus: A study on the role of chewing gum to reduce its duration. Saudi Surg J 2018;6:85-8.  Back to cited text no. 1
  [Full text]  
Chapman SJ, Pericleous A, Downey C, Jayne DG. Postoperative ileus following major colorectal surgery. Br J Surg 2018;105:797-810.  Back to cited text no. 2
Su'a BU, Pollock TT, Lemanu DP, MacCormick AD, Connolly AB, Hill AG, et al. Chewing gum and postoperative ileus in adults: A systematic literature review and meta-analysis. Int J Surg 2015;14:49-55.  Back to cited text no. 3
Song GM, Deng YH, Jin YH, Zhou JG, Tian X. Meta-analysis comparing chewing gum versus standard postoperative care after colorectal resection. Oncotarget 2016;7:70066-79.  Back to cited text no. 4
Liu Q, Jiang H, Xu D, Jin J. Effect of gum chewing on ameliorating ileus following colorectal surgery: A meta-analysis of 18 randomized controlled trials. Int J Surg 2017;47:107-15.  Back to cited text no. 5


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