Post operative paralytic ileus remains a source of morbidity and major determinant of length of stay after abdominal operation. The average hospital stay due to improved technology has reduced in many field of medicine. But in surgical field the hospital stay is not reduced due to post operative complication.
In united states the incidence of postoperative ileus occurs in approximately 50% of clients who undergo major abdominal surgery.
In india 60 to 70% of clients with major abdominal surgery develop complication due to post operative complication due to post operative paralytic ileus which becomes the root cause for discomfort, prolonged hospital stay and economic burden.
Definition-Postoperative paralytic ileus
Post operative paralytic ileus is generally defined as a transient impairement of bowel motility after abdominal surgery, clinically characterized by bowel distention, lack of bowel sound and lack of passage of flatus and stool. In postoperative ileus, inhibition or small bowel motility is transient, and the stomach recovers within 24 to 48 hours, whereas colonic function takes 48 to 72 hours to return. Not all segments in the gastro intestinal tract are equally affected by postoperative paralytic ileus. The average paralytic state lasts between 24 to 72 hours. Twenty four hours in the small intestine, 24 to 34 hours in the stomach and between 48 to 72 hours iin the colon after major abdominal surgery. The effective duration of paralytic ileus is there for mainly on the return of colonic motility and in particular motility of the left colon.
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The pathogenisis of postoperative paralytic ileus is complex with multiple factors. These factors include inhibitory effects of sympathetic input, release of hormones, neurotransmitters and other mediators, an inflammatory reaction and the effects of anasthetics and analgesics.
Postoperative paralytic ileus can be diagnosed by timing of relatively low pitched, gurgling sound caused by the propulsion of the intestinal contents through the lower alimentary tract which is characterized by peristaltic movement, passage of gas and evacuation of faeces.
Electrical stimulation of the intestine.
Early postoperative feeding.
Medications like opoid antagonist(Methylnatrexone and alvimopan),prokinetic agents(bisacodyl), motilin receptor antagonist(erythromycin), dopaminergic antagonist(metaclopromide) are used.
A review of meta-analyses and randomized controlled trials on drugs used for post-operative ileus was reported by Yeh et al. There are three meta-analyses (2 on gum-chewing and 1 on alvimopan) and 18 clinical trials. Only gum chewing and alvimopan were effective in preventing ileus but due to safety concerns and costs with alvimopan, gum chewing may be preferred as first-line therapy.
SIGIFICANCE AND NEED FOR THE STUDY
Paralytic ileus is a significant medical problem and constitutes the most common reason for delayed discharge from the hospital after abdominal surgery. The economic impact of ileus has been estimated to be $750 million to $1 billion in the united states. More important than health care costs is patient discomfort. So the researcher found that after major abdominal surgery the postoperative paralytic ileus is the major problem. And the 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 adjuant treatment in postoperative care because it might contribute to shorter hospital stays.
Cavusoglu.Y.H, et al,(2008) they performed a prospective, randomized, controlled trial on chewing gum prevents the onset of paralytic ileus in Dr.Sami ulus hospital, Turkey. Addition of gum chewing to the standardized postoperative care of children with anastamosis was associated with a significantly earlier return of bowel function compared to simple postoperative management, and it was associated with an earlier discharge from hospital, although this earlier discharge had only minor clinical significance was found in hospital charges.
Fitzgerald JE, Ahmed I.(2009), in Nottingham they conducted a study on systematic review and meta-analysis of chewing-gum therapy in the reduction of postoperative paralytic ileus following gastrointestinal surgery. There were no significant differences in complication rates. Chewing-gum therapy following open gastrointestinal surgery is beneficial in reducing the period of postoperative ileus, although without a significant reduction in length of hospital stay. These outcomes are not significant for laparoscopic gastrointestinal surgery.
Hirayama I, Suzuki M, et.al,(2009), conducted a study on gum-chewing stimulates bowel motility after surgery for colorectal cancer in Gunma Prefectural Cancer Center, Japan. The first passage of flatus and stool in the chewing-gum group after operation were 35 and 50 hours, respectively, sooner for the controls. It was concluded that gum-chewing provides a simple and effective method to improve the postoperative state of clients.
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With the use of literature review the researacher found that postoperative paralytic ileus is the major complication after the major abdominal surgery, and it will increasing the hospital stay. As the researcher came across many cases with increasing hospital stay due to later bowel motility. Gum chewing aids early recovery from postoperative ileus and is an inexpensive and physiologic method for stimulating bowel motility and also it reduces the hospital stay. Based on this fact the researcher felt the need to assess the effectiveness of chewing gum among clients undergone major abdominal surgery.
STATEMENT OF THE PROBLEM
A quasi experimental study to evaluate the effectiveness of chewing gum in increasing bowel motility among clients undergone major abdominal surgery in selected hospital, Madurai.
To assess the level of bowel motility among clients undergone major abdominal surgery in control group.
To assess the level of bowel motility after administering chewing gum among clients undergone major abdominal surgery in experimental group.
To findout the difference in the level of bowel motility between experimental and control group.
To associate the relationship between the level of bowel motility and selected demographic variables among clients undergone major abdominal surgery.
Ho1 : There will be no association between the chewing gum and bowel motility among clients undergone major abdominal surgery .
Ho2 : There will be no significant association between the bowel motility with selected demographic variables after administering the chewing gum.
Effectiveness: In this study it refers to how well a treatment of chewing gum works in practice to increasing the bowel motility.
Chewing gum: In this study it refers that it is sugar free chewing gum consists of artificial sweetner(sorbitol). It is believed to enhance vagal cholinergic stimulation of gut, release of gastro intestinal hormone such as: gastrin, pancreatic polypeptide, and neurotensin. It was given three times a day from 25th hour postoperatively till the first defecation.
Bowel motility: In this study it refers that assessment of bowel motility involved three components.
High pitched, gurgling bowel sounds 5-7/minute is normal which assessed by auscultation method.
Passing of gas and
Defecation was assessed by subjective report of the patient.
Major abdominal surgery: In this study it refers to the laporotomy surgeries. The surgeries were the hemicolectomy, intestinal perforation closure & cholicystectomy.
Chewing gum :
is simple to administer.
acts as a non-stimulant laxatives.
increases the vagal cholinergic stimulation of gut and improve the secretions of Gastro Intestinal hormones such as gastrin, neuropectin and pancreatic polypeptidase.
increases the salivation and provide freshness.
prevents the halitosis.
decreases the mental stress.
will not cause any adverse effects.
Selection of sample by purposive sampling method.
The findings of the study will help to identify the effectiveness of chewing gum therapy in increasing the bowel motility among the clients undergone major abdominal surgery. It would be useful contribution for improving nursing care and reducing the length of hospital stay.