Gum chewing stimulates bowel motility in patients undergoing radical cystectomy with urinary diversion

Abstract

Objectives: Several studies have shown that gum chewing may stimulate bowel motility after gastrointestinal surgery. Because urinary diversion typically uses a segment of bowel, it is conceivable that patients undergoing cystectomy and diversion may benefit from gum chewing. This study aimed to determine whether gum chewing in the immediate postoperative period facilitates a return to bowel function in patients undergoing cystectomy and urinary diversion.

Methods: A total of 102 patients underwent radical cystectomy and urinary diversion for clinically localized bladder cancer. Each patient followed our institution's perioperative cystectomy care plan. The first cohort of patients underwent surgery between July 2004 and August 2005 and served as a comparison (control) group in which no gum was dispensed. The second cohort underwent surgery during September 2005 to July 2006. These patients were given chewing gum to begin on postoperative day 1. Outcome measures included time to flatus, time to bowel movement, length of hospital stay, and complications.

Results: The time to flatus was shorter in patients who received gum compared with controls (2.4 versus 2.9 days; P <0.001). Also, time to bowel movement was reduced in patients who received gum (3.2 versus 3.9 days; P <0.001). There was no significant difference in length of hospital stay between gum-chewing patients and controls (4.7 versus 5.1 days, respectively; P = 0.067). Gum chewing was well tolerated in all patients.

Conclusions: Gum chewing may speed the recovery of bowel function after cystectomy and diversion. These findings are consistent with outcomes in the colorectal surgery published data that support the use of chewing gum as an easy and inexpensive way to enhance recovery after surgery.