Douligeris Athanasios, Diakosavvas Michail, Kathopoulis Nikolaos, Kypriotis Konstantinos, Mortaki Anastasia, Angelou Kyveli, Chatzipapas Ioannis, Protopapas Athanasios
Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece.
J Minim Invasive Gynecol. 2023 Oct;30(10):783-796. doi: 10.1016/j.jmig.2023.06.015. Epub 2023 Jul 6.
To assess the effect of postoperative gum chewing on gastrointestinal function in women following laparoscopic gynecological surgery for benign indications.
We screened 5 major databases (Medline, Scopus, Google Scholar, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov) from inception till February 2023.
No language restrictions were applied. We included randomized controlled trials comparing the postoperative bowel function between patients who chewed and patients who did not chew gum postoperatively after laparoscopic gynecological procedures for benign indications.
TABULATION, INTEGRATION, AND RESULTS: Data from 5 studies on 670 patients were extracted and analyzed by 3 independent reviewers. Meta-analysis was performed with RevMan 5.4 software (Copenhagen: The Nordic Cochrane Center, The Cochrane Collaboration, 2020), with mean differences (MDs), pooled risk ratios, and random-effects model. Postoperative gum chewing significantly reduced the time to first bowel sounds and the time to first passage of flatus (MD -2.58 hours 95% confidence interval (CI) -4.12 to -1.04 p = .001 and MD -3.97 hours 95% CI -6.26 to -1.68 p <.001, respectively). The time to first defecation, the time to first postoperative patients' mobilization, the length of hospital stay, and the risk of postoperative bowel obstruction showed no statistically significant difference between the 2 groups. When subgroup analysis was performed according to the type of the laparoscopic procedure, it failed to reveal a positive impact of postoperative gum chewing in both the times to first passage of flatus and first defecation following laparoscopic hysterectomies (MD -5.35 hours 95% CI -10.93 to 0.23 p = .06 and MD -15.93 hours 95% CI -40.13 to 8.28 p = .20, respectively).
The results of the present meta-analysis support that postoperative gum chewing following laparoscopic gynecological procedures seems to have a positive effect on the early mobilization of the gastrointestinal tract. However, these results should be interpreted with caution due to the small number of the included randomized controlled clinical trials.
评估术后咀嚼口香糖对因良性指征接受腹腔镜妇科手术的女性胃肠道功能的影响。
我们检索了5个主要数据库（Medline、Scopus、谷歌学术、Cochrane对照试验中心注册库和Clinicaltrials.gov），检索时间从建库至2023年2月。
不设语言限制。我们纳入了比较因良性指征接受腹腔镜妇科手术后咀嚼口香糖与未咀嚼口香糖患者术后肠功能的随机对照试验。
制表、整合与结果：3名独立评审员提取并分析了5项涉及670例患者的研究数据。使用RevMan 5.4软件（哥本哈根：北欧Cochrane中心，Cochrane协作网，2020）进行荟萃分析，采用平均差（MDs）、合并风险比和随机效应模型。术后咀嚼口香糖显著缩短了首次肠鸣音出现时间和首次排气时间（MD -2.58小时，95%置信区间（CI）-4.12至-1.04，p = 0.001；MD -3.97小时，95% CI -6.26至-1.68，p < 0.001）。两组在首次排便时间、术后首次活动时间、住院时间以及术后肠梗阻风险方面无统计学显著差异。根据腹腔镜手术类型进行亚组分析时，未发现术后咀嚼口香糖对腹腔镜子宫切除术后首次排气时间和首次排便时间有积极影响（MD -5.35小时，95% CI -10.93至0.23，p = 0.06；MD -15.93小时，95% CI -40.13至8.28，p = 0.20）。
本荟萃分析结果支持腹腔镜妇科手术后咀嚼口香糖似乎对胃肠道早期活动有积极影响。然而，由于纳入的随机对照临床试验数量较少，这些结果应谨慎解读。
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