The effect of chewing gum on bowel function postoperatively in patients with total laparoscopic hysterectomy: a randomised controlled trial

We aimed to investigate the efficacy of chewing gum on bowel movements after minimally invasive gynaecologic surgery, total laparoscopic hysterectomy (TLH). The study was designed as a prospective randomised controlled study. We divided the patients into two groups regarding postoperative chewing gum after elective TLH operation. The demographic status and characteristics of the patients as well as, anaesthesia and operation records were obtained. The study group was asked to chew gum for 15 min in an hour starting from post-operative 4th hour until the patient passed flatus. In each patient, first auscultation of bowel sounds, first flatus and first defaecation time, as well as first mobilisation time and discharge time, were recorded. We compared the difference in abdominal distension, nausea and vomiting and post-operative ileus (POI) rates. Eight patients were excluded from the study due to matching with exclusion criteria. The remaining 126 patients were divided into two groups. First bowel sounds, first bowel movements, the timing of first gas discharge and the timing of the first defaecation was found significantly earlier in the given-chewing gum group (p  .05). Mild symptoms of ileus were observed in two patients (3.2%) in the not given-chewing gum group and three patients (5.5%) in the given-chewing gum group. The symptoms were better tolerated by the patients who chew gums and no side effects regarding the treatment were observed. In post-operative patient care after minimally invasive surgery, chewing gum has a beneficial effect on bowel movements. This inexpensive and well-tolerated procedure ameliorates gastrointestinal (GI) functions, whereas it has little benefit on early mobilisation and timing of the patient discharge after patients undergoing TLH.Impact Statement What is already known on this subject? There are many studies in the literature on the effect of gum on postoperative bowel movements, early mobilisation and short-term hospitalisation. However, there are still doubts about its use after minimally invasive surgery, especially in gynaecology practice. What do the results of this study add? Chewing gum after surgery is a well-tolerated, effective, safe, easy and convenient method and is easily accepted by patients. Its use by gynaecologists after TLH is still not clear. Our aim is to show the relationship between chewing gum and TLH with this study; We believe that early mobilisation after laparoscopic hysterectomy will not be of significant benefit after minimally invasive gynaecological surgeries as it is not significantly effective in early nutrition and early patient discharge. What are the implications of these findings for clinical practice and/or further research? Our statistically not significant results obtained in this study may change after conducting randomised prospective studies involving more patients. However, we believe that giving chewing-gum after laparoscopic hysterectomy will not have a significant benefit

The Relationship between Nifedipine and Postpartum Blood Loss in Patients with Preterm Labor

Background: The purpose of the study, to determine whether exposure to nifedipine before delivery is associated with an increased risk of postpartum blood loss in patients with preterm labor. Methods: This was a retrospective study screening a total of 486 patients who were admitted due to preterm labor from 2012 to 2019. Patients who were given nifedipine for tocolysis before delivery were considered as the study group (n: 240), and the patients who gave birth without getting tocolysis were considered as the control group (n: 246). The dose of nifedipine used during the last 24 hours, 72 hours and 1 week before delivery, the total dose of nifedipine given and the duration from the last dose to the delivery were recorded separately. Hemoglobin and hematocrit and platelet values measured before and 6 hours after delivery were recorded and postpartum bleeding amount was calculated. Results: No significant difference is observed in terms of mean difference between pre/postpartum hemoglobin and hematocrit levels between control group and nifedipine group (p > 0.05). But when subgroups that are created according to the time of use of nifedipine before delivery, a positive correlation was observed between difference in hemoglobin and hematocrit levels between prepartum and postpartum and nifedipine dosage for the last 24 hours (r = 0.176, p = 0.006), (r = 0.139, p = 0.030), but not for 72 hours or one week. Conclusions: The use of nifedipine in patients with preterm labor for tocolysis may be associated with increase in postpartum blood loss in the last 24 hours before delivery