Impact of chewing gum on delayed gastric emptying following pancreaticoduodenectomy

Abstract

Aim: Gum chewing is known to accelerate gastric emptying. This prospective study aimed to analyse effect of gum chewing following Pancreaticoduodenectomy (PD) with Pancreaticogastrostomy (PG), using historical control as comparison. Materials and methods: Between April 2014 and August 2014, 20 PD patients were managed with chewing gum protocol (chew sugarless gum for 30 minutes 8th hourly), compared with an equal number of matched historical controls treated by traditional protocol. Results: Both groups were comparable in demographic, preoperative, operative, postoperative variables.On statistical univariate analysis, DGE and its grading was significantly reduced (p = 0.031) in chewing gum intervention group, they were able to tolerate liquid (p = 0.005) and solid diet (p = 0.006) earlier, and passed stools earlier (4.7 vs 5.6 days, p = 0.007) with reduced post-operative stay (15 vs 20.35 days, p = 0.005), with no differences in morbidity and mortality in both groups. On multivariate analysis, gum chewing significantly reduced the incidence of DGE (time to removal of Nasogastric Tube, resumption of solid diet), time to passage of first flatus/first stool, post-operative stay. Gum chewing did not influence vomiting/abdominal distension, reinsertion of nasogastric tube, length of ICU stay. Electrogastrogram analysis showed an increase in gastric motility during gum chewing in the test group. Conclusion: Gum chewing following PD is easy, cheap, without any adverse events, significantly associated with early recovery of bowel function, reduced DGE and reduced hospital stay. Further research would clarify this effect. , i.e. the loss of skeletal muscle mass, is increasingly recognized as a risk factor for complication after major abdominal surgery. The aim of this study was to determine the predictive value of sarcopenia in the development of surgical complications after pancreatoduodenectomy. 183 consecutive patients undergoing pancreatoduodenectomy at our institution were included. 162 patients were operated for malignancy and 21 for benign disease. Patients operated for chronic pancreatitis were excluded from analysis. Sarcopenia was determined by measuring the skeletal muscle index on a pre-operative CT-scan. Sarcopenia was defined at a threshold of 52.4 cm 2 /m 2 for males and 38.9 for females. Patient files were reviewed for perioperative morbidity/mortality and survival. Complications were scored according to ClavieneDindo. Post-operative pancreatic fistulas were scored according to the ISGPF definition.A majority of patients (N = 154; 84%) were classified as sarcopenic. Fistulas occurred in 50 patients with sarcopenia, and 1 without (32% vs 3.4%; p < 0.0001). Grade B or C fistulas occurred in 33 vs 1 patients (21% vs 3.4%; p = 0.02). There was no significant difference in hospital stay, occurrence of Clavien >2 complications or perioperative mortality. By multivariate analysis, the only independent predictors of post-operative pancreatic fistulas were sarcopenia (p = 0.001) and soft pancreatic texture (p = 0.0...