Impact of Chewing Gum Protocol on Delayed Gastric Emptying Following Pancreaticoduodenectomy

ABSTRACT

Introduction: Delayed gastric emptying (DGE) is one of the most troublesome post-operative complications following pancreatic resection. Not only does it contribute considerably to prolonged hospitalization but it is also associated with an increased cost of treatment, necessitates the use of additional investigations and procedures, and can cause life-threatening complications. Aim: This study aims to study the feasibility of implementing chewing gum protocol in pancreaticoduodenectomy (PD) with pancreaticogastrostomy, using historical control for comparison. Materials and Methods: Patients having pancreatic, periampullary cancer and other diseases who were planned for elective PD procedures were included in the study. Patients were divided into two groups, control group Traditional protocol and intervention group Chewing gum intervention. The primary endpoint for this study was fixed as the occurrence of DGE following PD. Results: Statistical analysis showed significant differences in the occurrence of DGE and its related parameters such as time for the removal of nasogastric tube (NGT) and time to start an oral solid diet. It also showed a significant difference in secondary parameters such as time to first flatus, time to stools, and post-operative hospital stay. Multivariate analysis also showed a significant beneficial effect of chewing gum. Conclusion: In patients undergoing PD, implementing gum chewing in the early post-operative period is easy, inexpensive, and without any adverse events. Gum chewing has significantly reduced the incidence of DGE and its parameters such as time to the removal of NGT, resumption of solid diet, time to the passage of first flatus, time to the passage of first stool, and thereby reduced the post-operative hospital stay significantly.