The effect of gum chewing to enhance

intestinal peristaltic frequency

in patients postoperative laparotomy

By:
Ika Linawati , S.Kep., Ns., M.Kep
Syahirul Alim,S.Kp.,Ph.D,
Dr.dr. Adeodatus Yuda Handaya, S.pB-KBD., FinaCS
• A Quasy experimen study with nonequivalent
pretest and postest control group design
• In 62 postoperative lapaotomy patient
• At Banyumas Hospital
• On july – September 2018
 Background
• Annually, there are 234 million surgical
procedures throughout the world (WHO, 2014)
• The most common surgical procedure is
Laparotomy (Chauhan et al., 2017)
• Most of Laparotomy uses General Anethesia
(GA)

• Most of the laparotomy surgery uses General

Anesthesia (GA)
GA can inhibit parasympathetic nerve
impulses of the gastrointestinal tract
and result in postoperative intestinal
motility (Perry & Poter, 2005)

Intestinal motility causes

postoperative Ileus (IPO) if it lasts
for> 24 hours (Anderson et al., 2015)

Efforts to recover postoperative

peristaltic are needed, one of which is
by chewing gum (Aarts et al., 2012)
 Studies that have been Frequency of
conducted regarding the intestinal
effects of chewing gum peristaltic that
appears <3 times
are only limited to the
per minute can
time of the appearance of be at risk of
peristaltic, but not paralytic ileus
counting the frequency (Perry & Poter,
that appears 2005)
Theoretical Framework
 Inclusion
• Patients were aged 18-60
years.
• Post laparotomy with GA.
• Patients who were able to
chew gum.
• Patients who were willing to
be involved in the research.
Exclusion
• Surgical patients used ASA > 3.
• Patients with psychiatric disorders.
• Patients underwent surgery with
multi-organ resection (e.g.
intestinal, gastric and rectal cutting
operations).
• Complicated abdominal infection
(for example, infections from
appendicitis and large intestine to the
rectum and pus removal).
• Allergy to Xylitol
The difference test in frequency of intestinal
peristaltic between period of observations in
each group
6.00

p=0.000 a
5.00 5,03 b
Frequency of Intestinal Peristalsis

4.00

p=0.000

3.00 3,10 Intervention

2,84
Control

2.00

1,5
1,26
1.00

0,5
0,29
.00 0,03
Base Post1 Post2 Post3
 Effects of chewing gum on changes in
the frequency of intestinal peristaltic
Median (min - max)
Effect
Measurement p value z
Intervention (n = Control (n = 31) size (r)
31)
Difference in pre- 1.0 (0.0 - 2.0) 0.0 (0.0 - 1.0) 0.004* -2.84 0.36**
post I
Difference in Pre- 1.0 (0.0 - 4.0) 1.0 {(-1.0 - 1.0} 0.002* -3.13 0.39**
post II
Difference in Pre- 2.0 (0.0 - 6.0) 1.0 {(-1.0) - 2.0} 0.001* -4.20 0.53***
post III
Source: Primary data (2018)
Note: Analysis using the Mann Whitney test, * significance value p <0.05, ** moderate
effect value (0.3 <r <0.5), *** significant effect value (r> 5)
 DISCUSSION

The timing of this 2-3 hours after the

intervention is operation and
appropriate after the Chewing gum
because the ventilator is earlier has an
consciousness of released, some effect on faster
postoperative inflammatory recovery of
patients starts markers that affect gastrointestinal
returning within the frequency of function (Abd-el-
1-3 hours after intestinal maeboud et al.,
the operation peristalsis begin to 2009)
(Miller et al., increase
2011) (Ehtesham, 2017)
The results of this research also indicated that
both the intervention and control groups
experienced a significant increase in intestinal
peristalsis

The change in the control group was also significant because of the
mobilization actions given to the control group. Mobilization is
one of the actions that have an effect on intestinal
peristalsis in postoperative patients (Terzioglu et al., 2013).
Conclusion
• Chewing gum can increase the
frequency of intestinal peristalsis in
laparotomy postoperative patients
• Chewing gum has been proven to
increase the frequency of intestinal
peristalsis in postoperative
laparotomy with a significant effect
(r> 0.5)
 SUGGESTION
• Nurses and other healthcare workers can apply chewing gum as an
intervention to increase the frequency of intestinal peristalsis in laparotomy
postoperative patients in hospitals.
For institutions and • Hospitals can add chewing gum activity to their SOPs for treating
healthcare workers laparotomy postoperative patients

• Future researchers who are interested in researching the

effects of chewing gum can use the Randomized Controlled
For future Trial (RCT) research design.
researchers
• Future research will be more significant if conducted in
populations at risk for example in DM and geriatric patients.