Objectives: To determine the effectiveness of gum chewing in decreasing the post-operative ileus over the standard post-operative care in patients who underwent cesarean section
Methods: This is a prospective randomized control trial study which determined the efficacy of gum chewing in decreasing post-operative ileus among patients who underwent Cesarean section operation. The study population consists of patients who underwent elective or emergency Cesarean section in De La Salle University Medical Center from the period of May - July 2011. Excluded in the study are those who are with known allergies with phenylalanine gums, allergies with mint, patients who underwent general anesthesia, and with intra operative appendectomy, adhesiolysis or complicated manipulation of gastrointestinal tract. Patients are selected randomly, a computer generated randomization plan (Random permutation) and patient assigned accordingly as the time they were admitted. Patients were asked for a signed informed consent form. The researcher explained the significance and the method for the study, once consented; patients were given a brown envelope that contained green bubble gum or candies. This is a single blinded procedure, the master list was kept by other person and the numbers were according to the generated randomized plan. Both the case group (gum chewing group) and the control group (non gum chewing group) received standard post-operative care like diet progression, high back rest, deep breathing exercises and gradual ambulation. The case group or the gum chewing group received bag of pellets, together with schedule on what time she will chew the gum, and be instructed to chew 2 pellets 6 hours post operation, with head of bed elevated a minimum of 30 degrees for 30 minutes, then three times a day at set intervals: 0900, 1400, 2100, until the first bowel movement.
Results: Among the 85 patients who participated in this study, 26 (30.5%) of them experienced post-operative ileus. Patients categorized to group A (who chew gum and did not have ileus) is 37 (86%), on group B (who chew gum and had ileus) is 6 (13%), on group C (who did not chew gum and did not have ileus) is 22 (52%) and on group D is 20 (47%) with a relative risk value of 1.6427. The time of the first feeding was measured on hour 11.76 on Gum Group and hour 11.72 on non gum group (P=0.643). The Operative duration was on hour 1.35 in Gum group and hour 1.47 on Non Gum group(P=0.087). The first passage of flatus of stool was seen on post-operative hour 17.22 in the gum group and on hour 38.52 in the non-gum group (P=0.000). The first bowel movement was on post-operative hour 44.60 in the gum group and hour 60.10 in the non-gum group(P=0.000). The total length of hospital stay was 3.76 days in gum group, while 4.07 days in the non-gum group(p=0.062). There was a significant difference between the gum group and non-gum group for the time of flatus and bowel movement but not significantly different in duration of hospital days.
Conclusion: Gum chewing after Cesarean section is safe, well tolerated, and associated with rapid resumption of intestinal motility and but not with shorter hospital stay; with potential impact on reducing the overall healthcare costs in case of routine implementation.
Keywords: Gum Chewing, Sham Feeding, Ileus, Cesarean Section, Laparotomy