The efficacy of chewing gum on postoperative ileus following cesarean section in Enugu, South East Nigeria: A randomized controlled clinical trial

Abstract

Background: Postoperative ileus (POI) is a common complication following caesarean section. It impairs patients comfort; delays wound healing and prolong duration of hospital stay. Several methods have been used in the management of this condition with varying efficacy. Chewing gum postoperatively is a recent concept in the western world being advocated as a cost effective and comfortable management of POI.
Aim: The aim was to evaluate the efficacy of gum‑chewing in reducing POI following caesarean section in Enugu.
Materials and Methods: One hundred and eighty women booked for elective caesarean section were randomized into gum‑chewing group (n = 90) or control group (n = 90) The subjects chewed sugarless gum three times daily from 6 h postoperatively until the first passage of flatus. Each chewing session lasted 30 min. Elective cesarean section was carried out with a Pfannenstiel incision. Groups were compared primarily for time to first bowel sound, and first flatus. Secondary endpoints of comparison were time of operation to first defecation, and patient satisfaction concerning postoperative gum chewing. The Student’s t‑test and Pearson Chi‑square test and multiple linear regression were used for statistical analysis.
Results: The groups were comparable in age, body mass index (BMI) and duration of surgery. The mean time to first bowel sounds (21.9 ± 8.0 vs. 26.1 ± 10.0), mean time to first flatus (24.8 ± 6.4 vs. 30.0 ± 10.0) and mean time to defecation (30.7 ± 5.9 vs. 40.0 ± 9.0) were significantly reduced in patients that chewed gum compared with controls. P =0.02, 0.01, and 0.01, respectively. Patients were satisfied with gum chewing and no side‑effect was recorded. Previous surgery and duration of surgery were predictors on duration of POI, while age, BMI and parity had no effect.
Conclusion: Gum‑chewing has a beneficial effect on early return of bowel function following cesarean section and should be included in the postoperative management protocol.

Key words: Caesarean section, chewing gum, ileus