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Sham Feeding With Chewing Gum After Elective Colorectal Resectional Surgery: A Randomized Clinical Trial*

Lim, Patrick BMed; Morris, Owen James MBBS; Nolan, Gregory FRACS; Moore, Sarah BMed; Draganic, Brian FRACS; Smith, Stephen Ridley MS

doi: 10.1097/SLA.0b013e318286504a
Randomized Controlled Trials

Objective: To determine whether sham feeding with chewing gum improved gastrointestinal recovery after colorectal resection surgery, in the presence of routine postoperative feeding.

Background: Sham feeding with chewing gum has been shown to accelerate the return of gut function after colorectal surgery. This study sought to determine whether sham feeding with gum, after colorectal resection, accelerates return of gastrointestinal function in patients on a rapid feeding enhanced recovery program.

Methods: A randomized “two armed” controlled clinical trial was performed. Equal groups of open and laparoscopic colorectal resection surgical patients were recruited. Patients in the intervention arm received chewing gum 4 times a day postoperatively. All patients in the trial were placed on an established, standardized Enhanced Recovery After Surgery program. The primary outcome was time to return of gut function, assessed by time to flatus and first bowel motion. Secondary outcomes were time to tolerate diet, symptoms of ileus in the form of nausea, vomiting and distension, pain as assessed by analgesic consumption and visual analogue scales, complications, and length of hospital stay.

Results: A total of 161 patients were recruited. Postoperative morbidity was equivalent between groups, with no complications related to gum chewing. There was no difference between groups with respect to the primary outcomes of time to flatus and bowel motion. There was less perception of pain in the intervention group on days 2 to 5, and no difference with respect to all other secondary outcomes.

Conclusions: Sham feeding with gum, after open and laparoscopic colorectal resectional surgery is safe, but does not hasten the return of gastrointestinal function in patients who receive accelerated postoperative feeding. (ACTRN12607000538448)

The objective of this randomized clinical trial was to assess the efficacy of sham feeding for colorectal surgery in the setting of an Enhanced Recovery After Surgery program. A 2-armed trial, involving 168 (84 open and 84 laparoscopic) patients, revealed that chewing gum postoperatively did not accelerate the return of gut function in this group of patients.

John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia.

Reprints: Stephen Ridley Smith, MS, Department of Surgery, John Hunter Hospital, Lookout Road, New Lambton Heights Newcastle, NSW 2305, Australia. E-mail:

Disclosure: No support, financial or otherwise, has been taken for this project internally or externally from any organization or institution. The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.