The Effect of Postoperative Gum Chewing on Gastrointestinal Function Following Laparoscopic Gynecological Surgery. A Meta-analysis of Randomized Controlled Trials

Athanasios Douligeris; Michail Diakosavvas; Nikolaos Kathopoulis; Konstantinos Kypriotis; Anastasia Mortaki; Kyveli Angelou; Ioannis Chatzipapas; Athanasios Protopapas

doi:10.1016/j.jmig.2023.06.015

The Effect of Postoperative Gum Chewing on Gastrointestinal Function Following Laparoscopic Gynecological Surgery. A Meta-analysis of Randomized Controlled Trials

J Minim Invasive Gynecol. 2023 Oct;30(10):783-796. doi: 10.1016/j.jmig.2023.06.015. Epub 2023 Jul 6.

Authors

Athanasios Douligeris¹, Michail Diakosavvas², Nikolaos Kathopoulis², Konstantinos Kypriotis², Anastasia Mortaki², Kyveli Angelou², Ioannis Chatzipapas², Athanasios Protopapas²

Affiliations

¹ Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: thanosdouligeris92@gmail.com.
² Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece.

PMID: 37422054
DOI: 10.1016/j.jmig.2023.06.015

Abstract

Objective: To assess the effect of postoperative gum chewing on gastrointestinal function in women following laparoscopic gynecological surgery for benign indications.

Data sources: We screened 5 major databases (Medline, Scopus, Google Scholar, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov) from inception till February 2023.

Methods of study selection: No language restrictions were applied. We included randomized controlled trials comparing the postoperative bowel function between patients who chewed and patients who did not chew gum postoperatively after laparoscopic gynecological procedures for benign indications.

Tabulation, integration, and results: Data from 5 studies on 670 patients were extracted and analyzed by 3 independent reviewers. Meta-analysis was performed with RevMan 5.4 software (Copenhagen: The Nordic Cochrane Center, The Cochrane Collaboration, 2020), with mean differences (MDs), pooled risk ratios, and random-effects model. Postoperative gum chewing significantly reduced the time to first bowel sounds and the time to first passage of flatus (MD -2.58 hours 95% confidence interval (CI) -4.12 to -1.04 p = .001 and MD -3.97 hours 95% CI -6.26 to -1.68 p <.001, respectively). The time to first defecation, the time to first postoperative patients' mobilization, the length of hospital stay, and the risk of postoperative bowel obstruction showed no statistically significant difference between the 2 groups. When subgroup analysis was performed according to the type of the laparoscopic procedure, it failed to reveal a positive impact of postoperative gum chewing in both the times to first passage of flatus and first defecation following laparoscopic hysterectomies (MD -5.35 hours 95% CI -10.93 to 0.23 p = .06 and MD -15.93 hours 95% CI -40.13 to 8.28 p = .20, respectively).

Conclusion: The results of the present meta-analysis support that postoperative gum chewing following laparoscopic gynecological procedures seems to have a positive effect on the early mobilization of the gastrointestinal tract. However, these results should be interpreted with caution due to the small number of the included randomized controlled clinical trials.

Keywords: Bowel motility; Gastrointestinal function; Gum chewing; Laparoscopic gynecology; Minimally invasive gynecology; Postoperative intervention.