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Thursday, June 13, 2013

Trailers (51): Post-laparoscopy gum chewing to enhance bowel motility

Husslein et al. Postoperative gum chewing after gynecologic laparoscopic surgery: a randomized controlled trial

Why should you read about this topic?

The quicker normal bowel function returns after surgery the happier your patients will be.

What were the authors trying to do?

Estimate the effect of postoperative gum chewing on bowel motility after laparoscopic gynecologic surgery

Who participated and in what setting?

Women (N=180) 18-80 years of age undergoing laparoscopic surgery (<3 h duration) for benign gynecologic conditions at the Klinikum Klagenfurt am Woerthersee in 2001-2

What was the study design?

Randomized controlled trial, outcomes assessor-masked, of 15 minutes of gum-chewing every two hours postoperatively

What were the main outcome measures?

Time to first flatus and time to normal bowel sounds

What were the results?

Interval to first flatus was less in the gum-chewing group (6.2 h v. 8.2 h).  Rate of normal bowel sounds at 3 hours was greater in the gum-chewing group (76% v. 47%).

What is the most interesting image in the paper?

Table 3

What were the study strengths and weaknesses?

Strengths: randomized, controlled trial; careful planning of timing of intervention and assessment to reduce observer bias.  Weaknesses: questionable effectiveness of masking observers; participant not masked to intervention; postoperative opiate use is a confounder; some procedures were very short (10 m), which may have diminished the estimate of the effect of the intervention; clinical trials registration was done after some participants were already enrolled.

What does the study contribute for your practice?

Does return of flatus 2 hours earlier make an important difference to your postop patients?  Probably not.  Gum-chewing is probably more important after laparotomies, bowel surgery, and extensive retroperitoneal dissection.