Chewing Gum vs Honey in Postoperative Recovery After Ileostomy Reversal: A Study Comparing Their Effects on Bowel Function, Complications, and Hospital Stay

"Comparison of the Effect of Chewing Gum and Honey on Postoperative Recovery and Complications in Ileostomy Reversal - A Pilot Randomized Controlled Trial"

• Introduction

Background

Ileostomy reversal is a standard procedure following temporary diversion surgeries, yet it's frequently complicated by issues such as ileus, delayed gastrointestinal function recovery (GIFR), infections, and longer hospital stays. Enhanced Recovery After Surgery (ERAS) protocols have emphasized early feeding and noninvasive stimulatory interventions like sham feeding (e.g., chewing gum), aiming to improve outcomes by accelerating return of bowel function. Honey, long known for its medicinal and antimicrobial properties, has also shown promise in enhancing gastrointestinal health and wound healing. However, its use postoperatively in gastrointestinal surgery, particularly ileostomy reversal, has not been well studied.

Rationale

This study addresses the research gap concerning the comparative effects of chewing gum and honey in enhancing postoperative recovery following ileostomy reversal. It aims to evaluate their efficacy in improving outcomes and reducing complications, using a pilot randomized controlled trial design.

• Objective

To compare the effects of chewing gum and honey on:

Time to bowel sounds, flatus, feces Time to full feeds Postoperative ileus Intraabdominal infection Nausea and vomiting Postoperative hospital stay

• Methods

Study Design

A prospective, single-blinded pilot randomized controlled trial was conducted at the West Surgical Ward, Mayo Hospital Lahore.

Participants

Sample size: 30 patients (15 per group) Inclusion: Adults (>18 years) undergoing ileostomy reversal after >1 month of stoma creation Exclusion: Malignancy, Irritable bowel disease (IBD), inability to chew/swallow, preexisting complications

Interventions

Group A (Gum): Chewed gum for 5 minutes every 4 hours, starting 24 hours postop Group B (Honey): Consumed ½ tablespoon honey every 4 hours, starting 24 hours postop

Outcomes

Primary: Time to bowel sounds, flatus, feces Secondary: Time to full feeds, PONV, pain score, discharge time, hospital stay, complications

Randomization & Blinding

Randomization was done using a lottery method. The study was single-blinded: participants were unaware of which group they were assigned to.

Data Collection

Standardized protocols for auscultation, patient self-reporting, and case report documentation were used. All participants completed the trial without loss to follow up.

Inclusion criteria

• All patients of age more than 18 years with an Ileostomy
• Undergoing surgery involving reversal of an Ileostomy i.e., Loop Ileostomy, Double Barrel Ileostomy, Ileocolostomy or End Ileostomy
• Time from fashioning of ileostomy to its reversal is of a duration greater than 1 month

Exclusion criteria

• Patients with existing complications as mentioned above in the operative definition of postoperative complications
• Patients with malignancy
• Patients with inflammatory bowel disease
• Patients who cannot communicate well
• Patients who have difficulty chewing or swallowing
• Patients who are prohibited from oral intake by the surgeon
• Patients having undergone Ileostomy reversal more than 1 day before being included in the study