Chewing Xylitol Gum could Accelerate Bowel motility Recovery after Elective Open Proctectomy for Rectal Cancer

Ping Yang, Department of Gastrointestinal Surgery, The East Branch of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China Affiliated Hospital & Sichuan Provincial People's Hospital, Chengdu 610110, Sichuan Province, China
Wu Jun Long, Department of Gastrointestinal Surgery, The East Branch of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China Affiliated Hospital & Sichuan Provincial People's Hospital, Chengdu 610110, Sichuan Province, China
Wei Li, Department of Gastrointestinal Surgery, The East Branch of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China Affiliated Hospital & Sichuan Provincial People's Hospital, Chengdu 610110, Sichuan Province, China

Background: A number of studies with conflicting results have evaluated the effect of chewing gum on post-operative gastrointestinal recovery in patients after major colorectal surgery. Objective: The objective of the study was to study the efficacy of chewing gum in patients with rectal cancer after elective open proctectomy only. Methods: A randomized controlled clinical trial was performed. We recruited patients who would undergo elective open proctectomy for rectal cancer in Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital. Patients in the intervention arm received chewing gum 3 times a day postoperatively. All patients in the trial were placed on the same perioperative management and standardized post-operative care plans. The primary outcome was time to the first peristalsis sounds, time to first flatus and the first defecation. Results: A total of 89 patients were recruited. The time to the first flatus was 42.33 ± 3.46 h in the gum group and 49.20 ± 1.42 h in the control group (p < 0.05). The time to the first defecation was significantly shorter in the gum-chewing group than in the control group (66.07 ± 2.36 vs. 78.37 ± 1.62 h; p < 0.05). Post-operative ileus (POI) was confirmed in 2 patients in the gum-chewing group and in 7 in the control group (7.0% vs. 23.9%; p = 0.028). Discussion: The present study suggests that chewing gum is a method to reduce the time to first flatus, time to first defecation and POI in patients undergoing elective open proctectomy for rectal cancer.

Keywords: Chewing gum. Rectal cancer. Rectal surgery.