Want to get colon resection patients out of the hospital a day early? Let them chew gum every day following surgery.
   That's the conclusion that may be drawn from the results of a multicenter study of 102 patients reported at the American College of Surgeons Clinical Congress in San Francisco. Chewing gum for 15 minutes four times daily alleviated postoperative ileus, reduced the time to first bowel movement after surgery by one day, and speeded discharge by just over a full day.
   "At 30 cents for a pack of gum and two to three packs per patient, we're talking about spending less than a dollar and getting patients out of the hospital a day early," reported Harry Papaconstantinou, MD, assistant professor of surgery at University of Texas Southwestern. "Daily hospital cost is estimated between $500 and $750. With all the laparoscopic colectomies being performed today, if we could save $500 for each one of them, the total savings would be quite significant."
   Postoperative ileus, the temporary loss of propulsive bowel activity, is the most common reason for prolonged hospitalization following abdominal surgery, Dr. Papaconstantinou noted. The condition can cause colicky pain, abdominal distension, constipation, vomiting and dehydration. The annual economic impact is between $750 million and $1 billion in the United States alone.
   Study patients were randomized into two groups. The control group received only sips of clear liquids following elective. The experimental group chewed a stick of gum for 15 minutes four times daily following surgery.
   The overall results were clear, Dr. Papaconstantinou said. The first bowel movement in the control group occurred 3.5 days post op compared with 2.9 days for gum chewers. Control patients went home 5.2 days after surgery compared with 4.4 days for the gum-chewing group.
   Researchers stratified both control and experimental patients into open colectomy and laparoscopic colectomy groups. Both controls and gum chewers had their first bowel movements 3.6 days after surgery. Gum chewers were discharged at 5.9 days, compared with 5.3 days for controls.
   The more significant improvement was seen following laparoscopic procedures. First bowel movement came 2.5 days after surgery for gum chewers vs 3.2 days for controls and length of stay was 3.8 days for gum chewers compared to 5.1 day for controls.
   "We do not know what facilitates the return of postoperative bowel function with gum chewing," Dr. Papaconstantinou said. "We speculate that it may be secondary to the effect of sham feeding."
   Other studies have shown sham feeding, chewing without swallowing, appears to stimulate enteric motility and reduce the time to initial bowel movement after surgery. Patients become bloated and nauseous if given full feeding soon after surgery.
   The colectomy results suggest that gum chewing could prevent postoperative ileus in other forms of abdominal surgery, Dr. Papaconstantinou said. He chose to study colectomy in order to avoid introducing additional variables, including the type of procedure.
   "This is something that needs to be investigated with other surgical procedures," he added.