Effect of chewing gum on clinical outcomes and postoperative recovery in adult patients after gastrointestinal surgery: an umbrella review

Background: Gastrointestinal surgery is crucial for many medical conditions but can lead to difficult recoveries. Chewing gum is proposed as a remedy, yet existing reviews offer conflicting results. This umbrella review aims to synthesize the effectiveness of chewing gum on time to first flatus, time to first bowel movement, length of stay and complication rates in adult patients. Methods: We conducted an umbrella review, searching seven databases up to 17 November 2023, with an updated search extending to 1 January 2025. The focus was on post-surgery chewing gum interventions. The quality and certainty of evidence were assessed using the AMSTAR-2 tool and umbrella review criteria. Results: Seventeen reviews, encompassing 26,672 participants from 264 primary studies, were included. Meta-analyses indicated reductions in time to first flatus by −0.36 days (95% CI = − 0.61, − 0.1) or −12.26 hours (95% CI = − 14.73, − 9.78), time to first bowel movement by −0.59 days (95% CI = − 0.94, − 0.23) or −19.29 hours (95% CI = − 23.79, − 14.79), and length of stay by −0.85 days (95% CI = − 1.22, − 0.48) or −20.08 hours (95% CI = − 28.62, − 11.54). Additionally, chewing gum was associated with fewer postoperative complications. Conclusion: Chewing gum may significantly aid postoperative care by reducing time to first flatus, time to first bowel movement, and length of stay. However, many included reviews were of low quality with weak evidence, highlighting the need for more rigorous studies to confirm these benefits. Integrating chewing gum into clinical practice could enhance recovery and optimise hospital bed turnover, making it a valuable addition to postoperative care protocols. Registration: PROSPERO Number: CRD4202451XXXX