• Karen Zaghiyan, Seth Felder, Gayane Ovsepyan, Zuri Murrell, Thomas Sokol, Beth Moore, and Phillip Fleshner.
• From the Division of Colorectal Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
• Dis. Colon Rectum. 2013 Mar 1;56(3):328-35.

BackgroundA number of small prospective studies with conflicting results have evaluated the effect of sugar-free chewing gum on postoperative GI recovery in patients initially maintained nil per os after major colorectal surgery.ObjectiveWe sought to evaluate the effect of sugared chewing gum in combination with early enteral feeding on recovery of GI function after major colorectal surgery to ascertain any additive effects of this combination.DesignThis was a randomized prospective study.SettingThis study was conducted at a single-institution tertiary referral center.PatientsPatients undergoing major colorectal surgery were included.InterventionsPatients were randomly assigned to sugared chewing gum (Gum) (instructed to chew 3 times daily; 45 minutes each time for 7 days postoperatively) or No Gum after major colorectal surgery.Main Outcome MeasuresThe primary outcome measured was time to tolerating low residue diet without emesis for 24 hours. The secondary outcomes measured were time to flatus, time to bowel movement, postoperative hospital stay, postoperative pain, nausea, and appetite.ResultsOne hundred fourteen patients (60 No Gum; 54 Gum) were included in our analysis after randomization. There was no significant difference in time to tolerating a low-residue diet, time to flatus, time to bowel movement, length of postoperative hospital stay, postoperative complications, postoperative pain, nausea, or appetite between patients assigned to Gum or No Gum. There was an increased incidence of bloating, indigestion, and eructation in the Gum group (13%) in comparison with the No Gum group (2%) (p = 0.03).LimitationsStudy subjects and investigators were not blinded. Multiple types of operations may cause intergroup variability.ConclusionsThere does not appear to be any benefit to sugared chewing gum in comparison with no gum in patients undergoing major colorectal surgery managed with early feeding in the postoperative period. There may be increased incidence of bloating, indigestion, and eructation, possibly related to swallowed air during gum chewing.

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