Postoperative ileus after laparotomy for gastrointestinal cancer treated with electroacupuncture: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the effect of electroacupuncture (EA) on postoperative ileus after laparotomy for gastrointestinal cancer.@*METHODS@#A total of 90 patients with postoperative ileus after laparotomy for gastrointestinal cancer were randomized into an EA group and a conventional treatment group, 45 cases in each one. In the conventional treatment group, the postoperative fast track surgical regimen was accepted. In the EA group, on the base of the treatment as the conventional treatment group, acupuncture was applied to Zusanli (ST 36), Shangjuxu (ST 37), Yinlingquan (SP 9) and Taichong (LR 3) and electric stimulation was attached on Zusanli (ST 36) and Yinlingquan (SP 9), with continuous wave, 2 Hz in frequency and 3-5 mA in intensity. Acupuncture was provided once daily till the onset of postoperative exhaust and defecation. The first postoperative exhaust time, the first postoperative defecation time, the postoperative hospital stay and the wound pain under standing on the next morning after entering group were compared in the patients between the two groups. The impact of the EA expectation was analyzed on the first postoperative exhaust time, the first postoperative defecation time and the postoperative hospital stay separately.@*RESULTS@#The first postoperative exhaust time and the first postoperative defecation time in the EA group were earlier than the conventional treatment group (P<0.05), the postoperative hospital stay was shorter than the conventional treatment group (P<0.05), and the rate of wound pain in the postoperative standing was lower than the conventional treatment group (P<0.05). EA expectation had no obvious correlation with the clinical therapeutic effect (P>0.05).@*CONCLUSION@#EA can relieve postoperative ileus symptoms, alleviate pain and shorten hospital stay in the patients after laparotomy for gastrointestinal cancer.

Role of gum chewing on the duration of postoperative ileus following lleostomy closure done for typhoid ileal perforation: a prospective randomized trial

There is ample evidence in the recent literature that gum chewing after elective colonic anastomosis decreases postoperative ileus [POI]. But there are very few studies on small bowel anastomosis done in relaparotomy cases. This study aimed to evaluate the effect of gum chewing on the duration of POI following small bowel anastomosis performed for the closure of intestinal stoma, made as temporary diversion in the selected cases of typhoid perforation peritonitis. Hundred patients undergoing elective small bowel anastomosis for the closure of stoma were randomly assigned to the study group [n=50] and the control group [n=50]. The study group patients chewed gum thrice a day for 1 h each time starting 6 h after the surgery until the passage of first flatus. The control group patients had standard postoperative treatment. Study and control group patients were comparable at inclusion. The mean time for the appearance of bowel sounds as well as the passage of first flatus was significantly shorter in the study group [P=0.040, P=0.006]. The feeling of hunger was also experienced earlier in study group cases [P=0.004]. The postoperative hospital stay was shorter in the study group, but the difference was not significant [P=0.059]. The cases of relaparotomy requiring additional adhesiolysis and small bowel anastomosis for stoma closure are benefited by postoperative gum chewing

Beneficio de la goma de mascar vs metoclopramida en la prevención del íleo postoperatorio de laparotomía / Benefit of chewing gum vs metoclopramide in the prevention of postoperative ileus ofter laparotomy

Analizar el beneficio de la goma de mascar y la metoclopramida en la prevención del íleo postoperatorio de laparotomía, Hospital Victorino Santaella Ruíz, octubre-noviembre 2009. Estudio prospectivo, cuasiexpemental. Un total de 60 pacientes post-operados de laparotomía fueron seleccionados y distribuidos equitativamente en 3 grupos: metoclopramida, goma de mascar y grupo control. Se registro el inicio de ruidos hidroaéreos, expulsión de flatos, evacuaciones y tolerancia completa a la vía oral en cada grupo. Los resultados fueron semetidos a un análisis de varianza de una sola vía y test de comparaciones múltiples. Con respecto al grupo control el grupo goma de mascar demostró ventaja al evaluar los factores ruidos hidroaéreos (p<0,05) y tolerancia completa a la vía oral (p<0.02). De la misma manera lo demostró el grupo metoclopramida (p<0,05) sobre el grupo control cuando se evaluó el factor flatos. Y en relación al factor evacuaciones ambos grupos terapéuticos demostraron igual superioridad sobre el grupo control (p<0.02). No se observaron diferencias significativas entre los grupos goma de mascar y metoclopramida. No se observaron diferencias significativas entre la administración de goma de mascar y metoclopramida, sin embargo al compararlos individualmente con el grupo control ambos mostraron beneficios estadísticamente significativos, que fueron mayores cuantitativamente en el grupo goma de mascar. En base a lo anterior y a otras ventajas como; la virtual ausencia de efectos secundarios, su bajo costo, su fácil y amplia disponibilidad, podemos recomendar el uso de goma de mascar para la prevención del íleo postoperatorio.

Analyze the benefit of chewing gum and metoclopramide in the prevention of postoperative ileus after laparotomy, Hospital Victorino Santaella Ruíz, octubre-november 2009. A prospective clinical trial carried out on 60 post-operatives of laparotomy patients. They were randomly assigned into three groups: metoclopramide, chewing gum and control group. The beginning of bowel sounds, flatus, bowel movements and complete food tolerance were recorded in each group. The data were analysed using the one-way variance method and the multiple comparison test. With respect to control group, the chewing gum group showed some statistical advantage when the factor, bowel sounds and complete food tolerance were compared (p<0,05) and (p<0.02) respectively. Metoclopramide showed advantage over the control group in regard to flatus factor (p<0,05). For the bowel movement factor, both therapeutic groups showed identical superiority compared to control group (p<0.02). There was no statistical diference between metoclopramide and chewing gum groups. There were not statistical difference between both therapeutic groups; nevertheless, when both of them were compared individually with the control group, the chewing gum group showed cuantitatively more advantages than metoclopramide group in the prevention of postoperative ileus. Based on the previously describe and other advantages as absence of side effects low cost and easy accessibility we can recommend the use of chewing gum in the prevention of postoperative ileus.

Effect of gum chewing on prevention of post cesarean ileus

Post cesarean ileus is a common complication that induces abdominal distention, delays feeding, and increases hospitalization. Multiple studies showed that false nutrition increases the bowel movement. This study aimed to investigate the effect of gum chewing as false nutrition on the bowel movement and prevention of post cesarean ileus. In this randomized controlled trial, a total of 400 patients who were hospitalized in Mashhad Zeinab hospital were divided into two 200-patient groups. The groups were matched for age, gravity and duration of surgery. In the intervention group, gum chewing was started after surgery, 3 times/day until the regular diet was initiated. In the control group, patients underwent routine care by restricting oral intake until the bowel function was returned. The outcomes were time of the first bowel sound, flatus passage, defecation, ambulation of patients post cesarean, initiation regular diet, and hospitalization. Statistical analysis was performed using unpaired t-test and fishers exact probability test. The mean age, parity and operation time were similar in the two groups. All patients in the intervention group tolerated gum chewing immediately after surgery. The results showed the followings among the intervention group vs. control group, respectively: post operative time intervals to bowel sounds [14.7 hours vs. 16.6 hours; P=0.569], time intervals between surgery and abdominal distention [16.59 hours vs. 14.21 hours; P=0.01], first post operative defecation [28.16 hours vs. 32.21 hours; P<0.000], post operative time interval to onset diet [19.3 hours vs. 16.54 hours; P=0.000], post operative time interval to ambulation [20.14 hours vs. 17.58 hours; P=0.000], post operative lengths of ileus [31.13 hours vs. 30.35 hours; P=0.5], hospitalization [1.84 days vs. 1.92 days; P=0.02]. Gum chewing after cesarean section is safe and well tolerated and reduces post operative ileus, shortens mean duration of first defecation, decreases the time of returning to regular oral diet, shortens the time of patient ambulation and hospital discharge. Gum chewing is offered as a physiologic and inexpensive method to prevent or reduce post cesarean ileus