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Publication - Dr Rebecca Kandiyali

    Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection

    Citation

    Atkinson, C, Penfold, CM, Ness, AR, Longman, RJ, Thomas, SJ, Hollingworth, W, Kandiyali, R, Leary, SD & Lewis, SJ, 2016, ‘Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection’. British Journal of Surgery, vol 103., pp. 962-70

    Abstract

    Background:
    Chewing gum may stimulate gastrointestinal motility with beneficial effects on postoperative
    ileus suggested in small studies. The primary aim of this trial was to
    determine whether chewing gum reduces length of hospital stay (LOS) after
    colorectal resection. Secondary aims included examining bowel habit symptoms, complications
    and healthcare costs.



    Method:
    This clinical trial randomly allocated postoperative patients to standard care with
    or without chewing gum (sugar-free gum for at least ten minutes, four times/day
    on days 1-5) in 5 UK hospitals. The primary outcome was LOS. Cox regression was
    used to calculate hazard ratios (HR) for LOS. Differences between groups for the
    selected secondary outcomes were assessed using Student’s t-test, χ2
    and Mann-Whitney tests as appropriate.



    Results:
    Data from 402 of 412 patients, of whom 199 (49.5%) were allocated to chewing
    gum, were available for analysis. 40% of patients in both groups had
    laparoscopic surgery, and all study sites used enhanced recovery after surgery
    programmes. Median (IQR) LOS was not different between groups with both 7 (5-11)
    days (p=0.962) showing a HR for gum at 0.94 (95% CI=0.77-1.15, p=0.557). Compared
    to controls, participants allocated to gum had worse quality of life (EQ-5D-3L)
    at 6 and 12 weeks post-operation (but not day 4), and more Dindo-Demartines-Clavien
    complications graded 3 and above and deaths (6 vs. 16 and 0 vs. 11,
    respectively, but none were classed as related to gum). No other differences
    were observed.



    Conclusion:
    Chewing gum did not alter the return of bowel function or LOS.



    Trial
    registration: ISRCTN55784442



    Full details in the University publications repository