First flatus time and xerostomia associated with gum‐chewing after liver resection

Aims and objectives. The aim of this study was to compare the return of bowel function and xerostomia in patients who were and were not instructed to chew gum after elective open liver resection. Background. Patients who undergo liver resection have limited early ambulation, because they require bed rest after surgery to prevent internal bleeding. They normally also require narcotic analgesics or patient‐controlled analgesia for pain control. For these reasons, they often have symptoms of intestinal gas accumulation, abdominal distension and/or abdominal pain. Design. Prospective case–control study. Methods. Forty‐two patients with hepatocellular carcinoma who were treated at Samsung Medical Center from September 2010 to February 2011 were included in this study. Patients who were scheduled for elective liver resection for hepatocellular carcinoma and were over 30 years of age were eligible. Patients were assigned to a gum‐chewing group or a non‐gum‐chewing (control) group before surgery. Results. The mean age of the gum‐chewing group was 54·9 (±9·7) years, and the mean age of the control group was 55·1 (±8·4) years. The mean values of first flatus time and xerostomia were higher in the control group than in the gum‐chewing group. First flatus time and xerostomia grade were significantly decreased in gum‐chewing group compared with the control group after adjustment for hospitalisation days, duration of surgery and amount of analgesics administered. Conclusion. Patients who were instructed to chew gum after surgery demonstrated faster bowel function recovery and lower xerostomia grade after elective open liver resection than patients who did not chew gum. Relevance to clinical practice. Gum‐chewing is an inexpensive, helpful adjunct to standard postoperative care after liver resection.