# Abstract

 # Abstract

 

## Background: In some studies, gum-chewing was demonstrated to have a beneficial effect on resumption of bowel function; however, other contradictory findings in other studies refute the effects of gum-chewing on peristaltic movements and digestive system stimulation. In addition, most previous studies were after colorectal or gynecology surgery, whereas few reports focused on the effect of gum-chewing after gastrectomy. The aim of this randomized controlled trial was to assess the effectiveness of gum-chewing on postoperative bowel function in patients who had undergone laparoscopic gastrectomy. 

## Methods: From March 2014 to March 2016, 75 patients with gastric cancer received elective laparoscopic surgery in Shanghai Tongji hospital and were postoperatively randomly divided into 2 groups: 38 in a gum-chewing (Gum) group and 37 in a control (No gum) group. The patients in the Gum group chewed sugarless gum 3 times daily, each time for at least 15 minutes, until the day of postoperative exhaust defecation. 

## Results: The mean time to first flatus (83.4 ± 35.6 vs. 79.2 ± 24.2 hours; *P* = 0.554) and the mean time to first defecation (125.7 ± 41.2 vs. 115.4 ± 34.2 hours; *P* = 0.192) were no different between the no gum and Gum groups. There was also no significant difference in the incidence of postoperative ileus (*P* = 0.896) and postoperative hospital stay (*P* = 0.109) between the 2 groups. The postoperative pain score at 48 hours (*P* = 0.032) in the Gum group was significantly higher than in the no gum group. There was no significant difference between the 2 groups in regards to patient demographics, comorbidities, duration of surgery, complications, and nausea/vomiting score. 

## Conclusion: Gum-chewing after laparoscopic gastrectomy did not hasten the return of gastrointestinal function. In addition, gum-chewing may increase patient pain on the second postoperative day. # Results Between March 2014 and March 2016, 85 patients participated in this trial. After 10 patients were excluded before randomization (see flowchart), a total of 75 patients were randomly assigned to either the Gum (n = 38) or No gum (n = 37) group. Baseline characteristics were similar between the 2 groups (Table [2](#)). There were no differences in sex, age, comorbidities, and ASA grade. Twenty-one patients in the No gum group had comorbidities before their operations, as did 21 patients in the Gum group. The most common comorbidities included primary hypertension, type 2 diabetes mellitus, post-stroke syndrome, and coronary artery disease. ::::table-wrap

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Baseline characteristics.
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![](<>):::: The operation outcomes for both groups are shown in Table [2](#). Two cases in the No gum group and 4 cases in the Gum group were converted to open surgery. There was no significant difference in the duration of operation between the 2 groups. The rates of POI of the 2 groups did not significantly differ. In the No gum group, 1 patient developed CD grade I complications: wound infection requiring dressing change. Grade II complications occurred in 2 patients: pneumonia requiring antibiotics. One patient developed a grade III complication: pleural effusion and atelectasis requiring thoracocentesis under local anesthesia. In the Gum group, 1 patient developed CD grade I complications: wound infection requiring dressing change. Grade II complications occurred in 4 patients: 2 developed pneumonia requiring antibiotics, 1 developed liver abscess requiring antibiotics, and 1 developed congestive heart failure requiring cardiac glycosides and diuretics. Two patients developed a grade III complication: pleural effusion and atelectasis requiring thoracocentesis under local anesthesia. There was no perioperative mortality in this series. Patient-controlled analgesia (PCA) with fentanyl was administered to all the patients. There was no significant difference in fentanyl consumption between the 2 groups (*P* = 0.969). As shown in Table [3](#), there was no significant difference in the mean time to the onset of gas passage (*P* = 0.554) or defecation (*P* = 0.192) between the 2 groups. There was also no significant difference in the incidence of POI (*P* = 0.896) and postoperative hospital stay (*P* = 0.109) between the 2 groups. ::::table-wrap
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Operative outcomes.
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![](<>):::: Pain scores after operation are listed in Table [4](#). We found that the 48-hour postoperative pain scores in the Gum group were significantly higher (*P* = 0.032). However, the 24-, 72-, and 72-hour-after pain scores were not significantly different between the 2 groups. We evaluated nausea and vomiting scores 24, 48, 72, and after 72 hours in the patients (Table [5](#)). Between the 2 groups, 24 hours, 48 hours, 72 hours, and 72 hours-after nausea and vomiting scores were not significantly different. ::::table-wrap
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Pain score after operation.
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![](<>):::: ::::table-wrap
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Nausea and vomiting score after operation.
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![](<>)::::


Extracted trial result:
Outcome: Consumption of fentanyl (continuous)
Intervention: Gum-chewing group
Comparator: No gum group
Intervention group size: 38
Comparator group size: 37