BACKGROUND: Postoperative ileus is a temporary disturbance in gastric and bowel motility following surgery. The risk for postoperative ileus following gastrointestinal and urinary ostomy surgery is significant because both procedures require extensive surgical manipulation and reconstruction of the bowel. Chewing gum is advocated for treatment because it acts as sham feeding, potentially stimulating gastric and bowel motility through repetitive stimulation of the cephalic-vagal complex.
OBJECTIVES: This Evidence-Based Report Card reviews and evaluates evidence related to the safety and efficacy of chewing gum as an intervention to reduce the duration of postoperative ileus.
SEARCH STRATEGY: We systematically reviewed the electronic databases CINAHL and MEDLINE from January 1996 to November 2009, using the terms “ileus” and “chewing gum.” We also searched the ancestry of the 21 articles returned by this review and searched Google Scholar. We included any study or meta-analysis of multiple studies that compared chewing gum to no treatment in patients undergoing abdominal surgery and creation of an intestinal or urinary stoma. We evaluated the following outcome measures: (1) time to passage of flatus, (2) time to passage of stool, or (3) length of hospital stay. Three meta-analyses and 4 studies met inclusion criteria.
RESULTS: Results of meta-analyses support the use of chewing gum for treatment of postoperative ileus. Chewing gum was consistently found to reduce time to passage of flatus and stool. One meta-analysis found that chewing gum reduced hospital stay but two found no difference. Analysis of studies reveal mixed results when chewing gum was compared to standard postoperative care in patients undergoing surgical reconstruction including ostomy surgery or creation of an orthotopic neobladder. The studies we reviewed were characterized by multiple limitations in design quality including small sample sizes, absence of multicenter trials, and lack of subanalyses of patients undergoing ostomy surgery.
IMPLICATIONS FOR PRACTICE: Current best evidence suggests that chewing gum should be offered to selected patients with the intent of decreasing postoperative ileus. A careful nursing assessment of the patient's mental status, aspiration risk, and dentition is needed before initiating the intervention. In addition, further research is needed to develop more clearly defined parameters for chewing gum including frequency and duration of chewing and its use in patients with nasogastric tubes.
Barbara J. Hocevar, BSN, RN, CWOCN, Nurse Manager, ET/WOC Nursing, Cleveland Clinic, Cleveland, Ohio.
Bruce Robinson, RN, Nurse Manager, Cleveland Clinic, Cleveland, Ohio.
Mikel Gray, PhD, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Professor and Nurse Practitioner, Department of Urology, University of Virginia, Charlottesville.
Corresponding author: Mikel Gray, PhD, FNP, PNP, CUNP, CCCN, FAANP, FAAN, Department of Urology, UVA 2nd Floor Room 2570, University of Virginia, PO Box 800422, Charlottesville, VA 22908 (firstname.lastname@example.org).