***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background / Aim : There is ample evidence in the recent literature that gum chewing after elective colonic anastomosis decreases postoperative ileus ( POI ) . But there are very few studies on small bowel anastomosis done in relaparotomy cases . This study aim ed to evaluate the effect of gum chewing on the duration of POI following small bowel anastomosis performed for the closure of intestinal stoma , made as temporary diversion in the selected cases of typhoid perforation peritonitis . Patients and Methods : Hundred patients undergoing elective small bowel anastomosis for the closure of stoma were r and omly assigned to the study group ( n=50 ) and the control group ( n=50 ) . The study group patients chewed gum thrice a day for 1 h each time starting 6 h after the surgery until the passage of first flatus . The control group patients had st and ard postoperative treatment . Results : Study and control group patients were comparable at inclusion . The mean time for the appearance of bowel sounds as well as the passage of first flatus was significantly shorter in the study group ( P=0.040 , P=0.006 ) . The feeling of hunger was also experienced earlier in study group cases ( P=0.004 ) . The postoperative hospital stay was shorter in the study group , but the difference was not significant ( P=0.059 ) . Conclusions : The cases of relaparotomy requiring additional adhesiolysis and small bowel anastomosis for stoma closure are benefited by postoperative gum chewing Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background and purpose Postoperative bowel dysfunction is still a major unsolved problem following transperitoneal abdominal aortic surgery . We conducted this study to establish if gum chewing during the postoperative period promotes recovery of bowel function following abdominal aortic surgery . Methods The subjects were 44 patients who underwent elective abdominal aortic surgery . The patients were allocated to a control group ( n = 21 ) , who received st and ard postoperative care , or a “ gum group ” ( n = 23 ) , who received st and ard postoperative care and were also given gum to chew three times a day from postoperative day ( POD ) 0–5 . Results The patient characteristics , intraoperative , and postoperative care were equivalent in both groups . Flatus was passed on POD 1.49 in the gum group and on POD 2.35 in the control group ( P = .0004 ) and the time to oral intake was 3.09 days in the gum group and 3.86 days in the control group ( P = .023 ) . The number of days to full mobilization in the hospital room was 3.35 versus 5.59 for the gum and control groups , respectively ( P < .0001 ) . Conclusions Gum chewing enhances early recovery of bowel function following transperitoneal abdominal aortic surgery . Moreover , it is a physiologically sound , safe , and an inexpensive part of the postoperative care Postoperative ileus ( POI ) is a transient loss of coordinated peristalsis precipitated by surgery and exacerbated by opioid pain medication . Ileus causes a variety of symptoms including bloating , pain , nausea , and vomiting , but particularly delays tolerance of oral diet and liquids . Thus POI is a primary determinant of hospital stay after surgery . ‘ Fast-track ’ recovery protocol s , opioid sparing analgesia , and laparoscopic surgery reduce but do not eliminate postoperative ileus . Alvimopan is a mu opioid receptor antagonist that blocks the effects of opioids on the intestine , while not interfering with their central ly mediated analgesic effect . Several large r and omized clinical trials have demonstrated that alvimopan accelerates the return of gastrointestinal function after surgery and subsequent hospital discharge by approximately 20 hours after elective open segmental colectomy . However , it has not been tested in patients undergoing laparoscopic surgery and is less effective in patients receiving nonsteroidal anti-inflammatory agents in a narcotic sparing postoperative pain control regimen . Safety concerns seen with chronic low dose administration of alvimopan for opioid bowel dysfunction have not been noted with its acute use for POI HYPOTHESIS Gum chewing after elective open colon resection may stimulate bowel motility and decrease duration of postoperative ileus . DESIGN AND SETTING Prospect i ve , r and omized study in a community-based teaching hospital . PATIENTS Thirty-four patients undergoing elective open sigmoid resections for recurrent diverticulitis or cancer . MAIN OUTCOME MEASURES First feelings of hunger , time to first flatus , time to first bowel movement , length of hospital stay , and complications . RESULTS A total of 34 patients were r and omized into 2 groups : a gum-chewing group ( n = 17 ) or a control group ( n = 17 ) . The patients in the gum-chewing group chewed sugarless gum 3 times daily for 1 hour each time until discharge . Patient demographics , intraoperative , and postoperative care were equivalent between the 2 groups . All gum-chewing patients tolerated the gum . The first passage of flatus occurred on postoperative hour 65.4 in the gum-chewing group and on hour 80.2 in the control group ( P = .05 ) . The first bowel movement occurred on postoperative hour 63.2 in the gum-chewing group and on hour 89.4 in the control group ( P = .04 ) . The first feelings of hunger were felt on postoperative hour 63.5 in the gum-chewing group and on hour 72.8 in the control group ( P = .27 ) . There were no major complications in either group . The total length of hospital stay was shorter in the gum-chewing group ( day 4.3 ) than in the control group ( day 6.8 ) , ( P = .01 ) . CONCLUSIONS Gum chewing speeds recovery after elective open sigmoid resection by stimulating bowel motility . Gum chewing is an inexpensive and helpful adjunct to postoperative care after colectomy Postoperative ileus is one of the common problems after abdominal surgeries . It contributes to delayed recovery and prolongs hospital stay . Sham feeding , such as gum chewing , may accelerate return of bowel function and reduce morbidity and length of hospital stay . This study aim ed to determine whether gum chewing in the immediate postoperative period facilitates a return to bowel function in cesarean-delivery patients . Three hundred eighty-eight patients who underwent cesarean delivery were r and omly assigned to a  gum-chewing group ( group G , N = 193 ) or a  control group  ( group C , N = 195 ) . Demographic data , duration of surgery , type of anesthesia , and time of discharge from hospital were recorded . Patients in the gum-chewing group chewed gum three times per day as soon as returning from the operating theater to the ward until the time they defecated or were discharged . Patients were asked to chew gum at least half an hour each time . The T test and Pearson chi-square test was used for statistical analysis . Groups were comparable in age , weight , height , weeks of gestation , duration of surgery , and type of anesthesia . Bowel sounds were 5 hours earlier in the gum-chewing group ( mean 18.2 hours ) than in the control group ( mean 23.2 hours ) . Passing flatus was 5.3 hours earlier in group G ( mean 34.6 hours ) than in group C ( mean 39.9 hours ) . Patients having mild ileus symptoms were 9 % less in group G ( mean 12 % ) than in group C ( mean 21 % ) . The difference between the two groups were all highly significant ( p < 0.001 ) . Gum chewing was easily tolerated without any complications . Gum chewing is an inexpensive , convenient , and physiological method in enhancing the recovery of bowel function . But this may not facilitate early hospital discharge , lactation , or defecation The aim of study was to investigate the effect of postoperative gum chewing on the recovery of bowel function after cesarean section . Total 100 women delivered by lower uterine segment section cesarean under local anesthesia ( spinal ) . Eligible patients were r and omly allocated into two groups : a gum-chewing group ( n=50 ) or a control group ( n= 50 ) . The gum-chewing group participants who received one stick of sugarless gum for one hours , three times daily immediately after recovery from anesthesia and the control group had the usual postoperative care until being discharged . All women were followed up regularly until discharge from hospital , and recorded the times to the ﬁrst bowel sounds of normal intestinal sounds , the time to the ﬁrst passage of ﬂatus , the time to the first feeling of hunger , and the time to the first defecation . The operative data , postoperative tolerance of gum chewing , and postoperative complications were documented . There was no statistically significant difference between the two groups in terms of demographic characteristics such as age , body mass index , parity , duration of surgery , number of miscarriages and curettages , time to the first feeding , the amount of serum intake , and type of cesarean section . The mean average postoperative interval of the first bowel sounds ( 21.9 versus 26.1 hours , p= 0.016 ) , the first feeling of hunger ( 11.8 versus 14.5 hours , p= 0.050 ) , the first passage of flatus ( 24.8 versus 30.0 hours , P=0.002 ) , the first defecation ( 30.6 versus 38.4 hours , P= 0.0001 ) was significantly shorter compared to the control group Abstract Hypothesis : It is suggested that chewing gum may accelerate postoperative intestinal transit recovery . Chewing gum may therefore produce the same result after open appendectomy . Design and setting : Prospect i ve , r and omized study in a University teaching hospital . Patients : 46 patients operated on by open appendectomy due to acute catarrhal appendicitis , appendicular abscess and appendicular generalized peritonitis . Main outcome measures : Interest was in occurrence of first flatus , first bowel movement , hospital duration and complications . Results : A total of 46 patients were r and omly divided into two groups : a chewing gum group ( n = 23 ) and a control group ( n = 23 ) . In the first group , patients chewed sugarless gum for 30 minutes thrice daily until resumption of intestinal transit . Patient demographics , intra-operative , and postoperative care were the same for both groups . Chewing gum was well tolerated by all the patients . The first passage of flatus occurred on postoperative day 2.2 in the gum-chewing group and on day 3.0 in the control group ( P < 0.0001 ) . The first bowel movement occurred at postoperative day 2.3 in the chewing gum group and at postoperative day 3.3 in the control group ( P < 0.0001 ) . Five complications were noted overall . Hospital stay was shorter in the chewing gum group ( 4.9 days . ) than in the control group ( 6.7 days ) , ( P < 0.0001 ) . Conclusion : Chewing gum ameliorates recovery after open appendectomy by reducing postoperative ileus . It is a cheap and helpful treatment to be recommended in developing countries in Africa BACKGROUND Postoperative ileus limits early hospital discharge for patients who have undergone laparoscopic procedures . Sham feeding has been reported to enhance bowel motility . Here , the effect of gum chewing is evaluated as a convenient method to enhance postoperative recovery from ileus after laparoscopic colectomy . STUDY DESIGN A total of 19 patients who underwent elective laparoscopic colectomy for colorectal cancer participated in the study . Each patient was r and omly assigned to one of two groups : a gum-chewing group ( n = 10 , mean age 58.6 years , range 50 to 71 years ) or a control group ( n = 9 , mean age 60.6 years , range 45 to 80 years ) . The patients in the gum-chewing group chewed gum three times a day from the first postoperative AM until oral intake . The times of the first passage of flatus and defecation were recorded precisely . RESULTS The first passage of flatus was seen , on average , on postoperative day 2.1 in the gum-chewing group and on day 3.2 in the control group ( p < 0.01 ) . The first defecation was 2.7 days sooner in the gum-chewing group ( postoperative day 3.1 ) than in the control group ( 5.8 days ; p < 0.01 ) . All patients tolerated gum chewing on the first operative AM . The postoperative hospital stays for the gum-chewing and control groups were 13.5+/-3.0 days and 14.5+/-6.1 days , respectively . CONCLUSIONS Gum chewing aids early recovery from postoperative ileus and is an inexpensive and physiologic method for stimulating bowel motility . Gum chewing should be added as an adjunct treatment in postoperative care because it might contribute to shorter hospital stays PURPOSE The study was design ed to investigate the influence of gum chewing on the return of gastrointestinal function after gastric abdominal surgery in children and the action of neural and humoral hormones in the mechanism of g 
    Output:
    
Results of the meta- analysis suggest that chewing gum following abdominal surgery offers benefits in reducing the time of postoperative ileus