Gum Chewing Speeds Postop Ileus Resolution


SAN FRANCISCO — A pack of chewing gum can save laparoscopic abdominal surgery patients over $500 in hospitalization costs?

That's what a randomized study of postoperative ileus and “sham feeding” found.

Estimates are that half of inpatient abdominal and pelvic surgery patients do not have a return of bowel function for 4 days, and 25% have not had a return by 6 days. The cost of postoperative ileus nationally is estimated to be $750 million to $1 billion a year.

A number of investigators have begun to explore the use of sham feeding—that is, chewing without swallowing food—to see whether it can cause cholinergic stimulation of the gut and speed the return to normal bowel function following abdominal surgery.

This study took that concept to the next level, James T. McCormick, D.O., said at the annual clinical congress of the American College of Surgeons. It found that laparoscopic colectomy patients randomized to chewing four sticks of gum a day had their first defecation and were discharged from the hospital almost a day earlier than other patients.

The study, which enrolled 102 patients undergoing elective colectomy, included both open colectomy and laparoscopic colectomy patients. However, the benefits were seen only in the patients who had a laparoscopic procedure, said Dr. McCormick of the Western Pennsylvania Hospital, Pittsburgh.

In the laparoscopic patients, the 42 patients who chewed gum had an average time to first bowel movement of 2.9 days, compared with an average of 3.5 days in the 20-patient, clear-liquid control group, and were released from the hospital in 4.4 days, compared with 5.2 days.

Patients in the study began to receive solid food when it was deemed that they could tolerate it, and there was no difference between the groups in hunger or vomiting. The patients who chewed gum were given the gum at mealtimes and one time in the evening to simulate a snack. By protocol, they chewed for 15 minutes.

“Is more chewing better? I don't know,” Dr. McCormick said.

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