The Effect of Gum Chewing on Return of Bowel Function After Abdominal Surgery in Children Over the Age of 4 Years
Trial Snapshot
- Phase
- Not Applicable
- Status
- Withdrawn
- Sponsor
- Alberta Children's Hospital
- Locations
- 1
- Primary Endpoint
- composite outcome: first flatus, first bowel movement, first solid oral intake (any)
Study Overview
Brief Summary
Traditional postoperative care has been challenged recently to improve and speedup recovery (including the return of bowel function) such that patients can be discharged to home more quickly. This approach includes earlier mobilization of the patient, and introducing solid food sooner. Additionally, there is evidence in adults to suggest that "sham feeding" by chewing gum may also speed up bowel recovery so the patient may tolerate a solid diet earlier.
The aim of this study is to determine if gum chewing can enhance bowel recovery in children who undergo abdominal surgery.
Detailed Description
After intestinal surgery, many patients suffer from a "postoperative ileus" (POI). The cause is multifactorial and can be attributed to surgery itself, the lingering effect of the anesthetic, the use of narcotics and decreased mobility of the patient.
An ileus can delay the time to full diet, thus lengthening the hospital stay of the patient - sometimes up to several weeks.
There is evidence that early drinking/eating and increased mobility may accelerate the return of bowel function. "Fast-tracking" is well documented in the adult literature; protocols have been put in place to enhance GI tract recovery and thus decrease the morbidity of a prolonged hospital stay and ileus. "Fast-tracking" has been done in pediatric patients but not in a large RCT for abdominal surgery.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- Single (Outcomes Assessor)
Eligibility Criteria
- Ages
- 4 Years to 18 Years (Child, Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •children more than 4 years of age
- •children who undergo abdominal surgery (both laparoscopic or open)
- •children who have an expected postoperative length of stay more than 24 hours
Exclusion Criteria
- •children who are less than 4 years of age
- •children who are unable to chew gum/swallow (e.g. intubated, decreased level of consciousness, cognitive or physical disability)
- •children or their parents are not willing to sign consent
- •children or their parents are unable to follow directions regarding gum chewing,
- •children who have a GI dysmotility disorder (e.g. chronic intestinal pseudo-obstruction)
Arms & Interventions
No gum chewing
Usual pharmacologic treatment and post-operative care (e.g. daily visits by surgical team, antibiotics where appropriate, mobilization, advancement of diet as tolerated). Analgesia and anti-emetics will be provided (both oral and intravenous) as needed.
Gum chewing
Usual pharmacologic treatment and post-operative care (e.g. daily visits by surgical team, antibiotics where appropriate, mobilization, advancement of diet as tolerated). Analgesia and anti-emetics will be provided (both oral and intravenous) as needed.
Intervention: 1 piece of sugarless gum to be chewed three times daily for 1 hour each.
Intervention: Gum chewing (Other)
Outcomes
Primary Outcomes
composite outcome: first flatus, first bowel movement, first solid oral intake (any)
Time Frame: from time of leaving the operating room (time zero) until the time of event (time bowel movement, time flatus, time oral intake), measured in hours
documented by nurse, patient or caregiver
Secondary Outcomes
- Readmission(days)
- length of stay(days)
- Swallowing/aspiration of gum(during hospital stay (from leaving the operating room until discharge))
- Allergic reaction/adverse reaction to gum(during hospital stay (from leaving the operating room until discharge))
- Reoperation(during same hospital stay (from leaving the operating room until discharge))
- prokinetic/anti-reflux medication(during admission (from leaving the operating room until discharge))
- Narcotic use(during admission (from leaving the operating room until discharge))
Investigators
Dr Anna Shawyer
Pediatric Surgeon
Alberta Children's Hospital