Effect of sham feeding with gum chewing on postoperative ileus after liver transplantation - A randomized controlled trial.
Lee, H., C. W. Cho, et al.Clinical Transplantation 2016 [record in progress].
Aims
To evaluate the effect of gum chewing in reducing the time to first flatus and on oral calorie intake in patients undergoing living or deceased donor liver transplantation.
Interventions
Participants were randomly assigned to either the intervention group and chewed two pieces of sugarless xylitol flavoured gum for 15 minutes three times a day at regular meal times (group S), or to the control group and received no gums during the postoperative ileus period (group C).
Participants
64 patients aged ≥ 20 years scheduled for living or deceased donor liver transplantation who had no previous gastrointestinal tract surgery or absent or unsuitable dentures for chewing gum.
Outcomes
The primary outcome measured was time from intensive care unit (ICU) admission to first flatus. Secondary outcomes included time to sips of water, time to soft blended diet, cumulative energy intake, and ICU and hospital length of stay.
Follow-up
End of hospital stay
CET Conclusions
This is a carefully done RCT examining the role of gum chewing on post-operative ileus after liver transplantation. There is a good deal of evidence suggesting that gum chewing after major abdominal surgery does reduce the time to the first passage of flatus and the first sips of water, but to be honest, although statistically significant in a meta-analysis, it is not all that impressive. However, the authors planned to study gum chewing versus no gum chewing in patients after liver transplantation which does represent a very major abdominal insult and post-operative ileus is common. The primary outcome, namely the time to the first passage of flatus, was no different between the control group and the gum chewing group, nor was there any difference in the caloric intake and length of Intensive Care Unit stay. Thus, the authors conclude that sham feeding by gum chewing did not shorten the duration of post-operative ileus, nor facilitate oral intake after liver transplantation.
Data analysis
Modified intention-to-treat analysis
Trial registration
Clinicaltrials.gov number - NCT 01956643