When postoperative ileus is not resolved after 5 days or recurs after resolution, prolonged postoperative ileus is diagnosed.
Prolonged postoperative ileus increases discomfort, morbidity and hospitalization length, and is mainly caused by an inflammatory response following intestinal manipulation.
This response can be weakened by targeting the cholinergic anti-inflammatory pathway, with nicotine as essential regulator.
Chewing gum, already known to stimulate gastrointestinal motility itself, combined with nicotine is hypothesized to improve gastrointestinal recovery and prevent prolonged postoperative ileus.
Dr Daniël Lambrichts and colleagues from the Netherlands assessed the efficacy and safety of nicotine gum in colorectal surgery.
|In both groups, 6 patients developed prolonged postoperative ileus|
|International Journal of Colorectal Diseases|
Patients undergoing elective oncological colorectal surgery were enrolled in this double-blind, parallel-group, controlled trial and randomly assigned to a treatment protocol with normal or nicotine gum.
Patient reported outcomes, clinical characteristics and blood samples were collected.
The research team's primary endpoint was defined as time to first passage of feces and toleration of solid food for at least 24 hours.
In total, 40 patients were enrolled.
In both groups, the team reported that 6 patients developed prolonged postoperative ileus.
The researchers found that time to primary endpoint and length of stay did not differ significantly between normal and nicotine gum.
There were no differences in patient reported outcomes, inflammatory parameters and postoperative complications.
Dr Lambrichts' team concludes, "We proved nicotine gum to be safe but ineffective in improving gastrointestinal recovery and prevention of prolonged postoperative ileus after colorectal surgery."
"Other dosages and administration routes of nicotine should be tested in future research."