Gum chewing reduces postoperative ileus? A systematic review and meta-analysis.

BACKGROUND: An important cause of delayed recovery from intestinal surgery is postoperative ileus. Gum chewing is a form of sham feeding, which could encourage gastrointestinal motility through cephalic-vagal stimulation. METHODS: We sought to identify all randomized controlled trials comparing gum chewing with standard care after elective intestinal surgery. We searched electronic databases (Cochrane, Embase, and PubMed), reference lists and contacted authors to obtain further data. We assessed the identified trials for quality and performed a meta-analysis and systematic review. The main outcome measures examined were time to flatus and stool postoperatively and length of hospital stay, which were analysed using random effect models. We also examined clinical complication rates. RESULTS: We identified nine eligible trials that had enrolled a total of 437 patients. The intervention was well tolerated and complication rates were low. There was statistical evidence of heterogeneity for the three main outcomes. Pooled estimates showed a reduction in time to flatus by 14 h (95% CI: -20 to -8h, p=0.001), time to bowel movement by 23 h (95% CI: -32 to -15 h, p<0.001) and a reduction in length of hospital stay by 1.1 days (95% CI: -1.9 to -0.2 days, p=0.016). CONCLUSIONS: Chewing sugarless gum following elective intestinal resection is associated with improved outcomes. Insufficient data were available to demonstrate a reduced rate of clinical complications or reduced cost. An adequately powered, methodologically rigorous trial of gum chewing is required to confirm if there are any benefits and if these result in differences in clinical outcomes such as infection.

Rectal cancer: the role of radiotherapy.

Surgery is the definitive tool in the management of patients with rectal carcinoma. Early failure of treatment remains problematic and is manifest in local recurrence. Development of surgical techniques and inclusion of other treatment modalities aim to reduce the incidence of local recurrence and improve survival. This article examines the role of radiotherapy in the management of patients with rectal carcinoma and explores the controversies that exist in its application. The evidence for the use and benefits of radiotherapy in adjuvant and neoadjuvant settings is reviewed, and its application in association with total mesorectal excision considered.