Influence of gum chewing on postoperative bowel activity after complete staging surgery for gynecological malignancies: a randomized controlled trial

Gynecol Oncol. 2013 Oct;131(1):118-22. doi: 10.1016/j.ygyno.2013.07.098. Epub 2013 Jul 29.


Objective: To investigate whether gum chewing affects the return of bowel function after complete staging surgery for gynecologic malignancies.

Methods: A total of 149 patients undergoing abdominal complete surgical staging for various gynecological cancers were randomized into a gum-chewing group (n=74) or a control group (n=75). The patients chewed sugarless gum three times from the first postoperative morning until the first passage of flatus. Each chewing session lasted 30 min. Total abdominal hysterectomy with systematic pelvic and para-aortic lymphadenectomy was performed on all patients as part of complete staging surgery. Groups were compared in terms of time to first bowel movement time, first flatus and feces pass time, postoperative analgesic and antiemetic drug requirement, postoperative oral intake tolerance, mild ileus symptoms and hospital stay.

Results: The mean time to flatus (34.0 ± 11.5 vs. 43.6 ± 14.0 h; p<0.001), mean time to defecation (49.6 ± 18.7 vs. 62.5 ± 21.5h; p<0.001), mean time to bowel movement (41.5 ± 15.7 vs. 50.1 ± 5.9h; p=0.001), mean time to tolerate diet (4.0 ± 0.8 vs. 5.0 ± 0.9 days; p<0.001), mean length of hospital stay (5.9 ± 1 vs. 7.0 ± 1.4 days; p<0.001) were significantly reduced in patients that chewed gum compared with controls. Mild ileus symptoms were observed in 27 (36%) patients in the control group compared to 11(14.9%) patients in the gum-chewing group [relative risk, 2.4; 95% confidence interval, 1.2-4.5; p=0.004]. Severe symptoms were observed in two patients (2.7%) in the control group.

Conclusions: Gum chewing early in the postoperative period following elective total abdominal hysterectomy and systematic retroperitoneal lymphadenectomy hastens time to bowel motility and ability to tolerate feedings. This inexpensive and well-tolerated treatment should be added as an adjunct in postoperative care of gynecologic oncology.

Keywords: Complete staging surgery; Gum chewing; Gynecologic malignancy; Postoperative bowel function; Retroperitoneal lymphadenectomy; Total abdominal hysterectomy.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aorta
  • Chewing Gum*
  • Defecation / physiology
  • Eating
  • Female
  • Flatulence / physiopathology
  • Genital Neoplasms, Female / surgery*
  • Humans
  • Hydronephrosis / congenital
  • Hysterectomy / adverse effects*
  • Ileus / etiology
  • Ileus / physiopathology
  • Ileus / therapy
  • Intestinal Diseases / etiology
  • Intestinal Diseases / physiopathology
  • Intestinal Diseases / therapy
  • Intestine, Large / physiopathology*
  • Length of Stay
  • Lymph Node Excision / adverse effects*
  • Multicystic Dysplastic Kidney
  • Neoplasm Staging
  • Postoperative Period
  • Recovery of Function*
  • Single-Blind Method
  • Time Factors
  • Ureteral Obstruction


  • Chewing Gum

Supplementary concepts

  • Multicystic renal dysplasia, bilateral