Title: The effect of chewing gum on postoperative ileus after laparotomy for gastroduodenal
perforations: A randomized controlled trial.
Version: 3 Date: 25 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The term "prolonged postoperative ileus" (PPOI) is used inconsistently. While it is defined
earlier in the text, the abbreviation “POI” appears to be used more frequently throughout the
study, and it might cause confusion. It would be helpful to standardize the terminology to avoid
ambiguity.
-The mention of Enhanced Recovery After Surgery (ERAS) protocols is important but feels
slightly underdeveloped. The authors state that ERAS measures have been shown to shorten
POI in elective surgeries but provide no evidence or explanation for their lack of application
in emergency cases. Given the focus of this study on emergency surgery, further elaboration
on how ERAS components could relate to chewing gum would help to contextualize this in the
existing framework for postoperative care.
-While the introduction emphasizes the benefits of chewing gum (e.g., reducing POI duration
and hospital stay), it would be helpful to mention any potential risks or limitations of this
intervention, even if minimal. For instance, issues such as difficulty chewing, poor tolerance
among patients, or possible concerns for patients with gastrointestinal issues (e.g., strictures,
obstructions) could be mentioned briefly to present a more balanced view.
-The introduction mentions that many hospitals in low-income countries still face challenges
such as access to minimally invasive surgery, but does not fully explore how this context might
affect the feasibility of implementing chewing gum as an intervention. It would be beneficial
to link the low-cost and readily available nature of chewing gum to the resource constraints in
these settings to underscore its potential value in such environments.
-It would be beneficial to include a brief mention of how tolerance to chewing gum was
monitored. For instance, were any participants unable to tolerate chewing gum, and how were
these instances handled? This is an important consideration given that some patients may
struggle with oral intake or have contraindications for early feeding.
-Although the authors note that complications were not statistically significant, the discussion
could benefit from more detailed exploration of why certain complications (e.g., burst abdomen
and leakage) were more common in the control group. Were there any patient-specific factors
(e.g., age, comorbidities, pre-existing nutritional status) that could explain these complications?
-Given that gum chewing was hypothesized to stimulate bowel motility and reduce
inflammation, it would be useful to discuss whether these mechanisms could have indirectly
influenced the risk of complications. For example, chewing gum could have led to improved
motility and better gut perfusion, reducing the incidence of bowel anastomosis leakage or
abdominal distension.
Title: The effect of chewing gum on postoperative ileus after laparotomy for gastroduodenal
perforations: A randomized controlled trial.
Version: 3 Date: 25 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The term "prolonged postoperative ileus" (PPOI) is used inconsistently. While it is defined
earlier in the text, the abbreviation “POI” appears to be used more frequently throughout the
study, and it might cause confusion. It would be helpful to standardize the terminology to avoid
ambiguity.
-The mention of Enhanced Recovery After Surgery (ERAS) protocols is important but feels
slightly underdeveloped. The authors state that ERAS measures have been shown to shorten
POI in elective surgeries but provide no evidence or explanation for their lack of application
in emergency cases. Given the focus of this study on emergency surgery, further elaboration
on how ERAS components could relate to chewing gum would help to contextualize this in the
existing framework for postoperative care.
-While the introduction emphasizes the benefits of chewing gum (e.g., reducing POI duration
and hospital stay), it would be helpful to mention any potential risks or limitations of this
intervention, even if minimal. For instance, issues such as difficulty chewing, poor tolerance
among patients, or possible concerns for patients with gastrointestinal issues (e.g., strictures,
obstructions) could be mentioned briefly to present a more balanced view.
-The introduction mentions that many hospitals in low-income countries still face challenges
such as access to minimally invasive surgery, but does not fully explore how this context might
affect the feasibility of implementing chewing gum as an intervention. It would be beneficial
to link the low-cost and readily available nature of chewing gum to the resource constraints in
these settings to underscore its potential value in such environments.
-It would be beneficial to include a brief mention of how tolerance to chewing gum was
monitored. For instance, were any participants unable to tolerate chewing gum, and how were
these instances handled? This is an important consideration given that some patients may
struggle with oral intake or have contraindications for early feeding.
-Although the authors note that complications were not statistically significant, the discussion
could benefit from more detailed exploration of why certain complications (e.g., burst abdomen
and leakage) were more common in the control group. Were there any patient-specific factors
(e.g., age, comorbidities, pre-existing nutritional status) that could explain these complications?
-Given that gum chewing was hypothesized to stimulate bowel motility and reduce
inflammation, it would be useful to discuss whether these mechanisms could have indirectly
influenced the risk of complications. For example, chewing gum could have led to improved
motility and better gut perfusion, reducing the incidence of bowel anastomosis leakage or
abdominal distension.
Please review this paper.
user
Title: The effect of chewing gum on postoperative ileus after laparotomy for gastroduodenal
perforations: A randomized controlled trial.
Version: 3 Date: 25 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The term "prolonged postoperative ileus" (PPOI) is used inconsistently. While it is defined
earlier in the text, the abbreviation “POI” appears to be used more frequently throughout the
study, and it might cause confusion. It would be helpful to standardize the terminology to avoid
ambiguity.
-The mention of Enhanced Recovery After Surgery (ERAS) protocols is important but feels
slightly underdeveloped. The authors state that ERAS measures have been shown to shorten
POI in elective surgeries but provide no evidence or explanation for their lack of application
in emergency cases. Given the focus of this study on emergency surgery, further elaboration
on how ERAS components could relate to chewing gum would help to contextualize this in the
existing framework for postoperative care.
-While the introduction emphasizes the benefits of chewing gum (e.g., reducing POI duration
and hospital stay), it would be helpful to mention any potential risks or limitations of this
intervention, even if minimal. For instance, issues such as difficulty chewing, poor tolerance
among patients, or possible concerns for patients with gastrointestinal issues (e.g., strictures,
obstructions) could be mentioned briefly to present a more balanced view.
-The introduction mentions that many hospitals in low-income countries still face challenges
such as access to minimally invasive surgery, but does not fully explore how this context might
affect the feasibility of implementing chewing gum as an intervention. It would be beneficial
to link the low-cost and readily available nature of chewing gum to the resource constraints in
these settings to underscore its potential value in such environments.
-It would be beneficial to include a brief mention of how tolerance to chewing gum was
monitored. For instance, were any participants unable to tolerate chewing gum, and how were
these instances handled? This is an important consideration given that some patients may
struggle with oral intake or have contraindications for early feeding.
-Although the authors note that complications were not statistically significant, the discussion
could benefit from more detailed exploration of why certain complications (e.g., burst abdomen
and leakage) were more common in the control group. Were there any patient-specific factors
(e.g., age, comorbidities, pre-existing nutritional status) that could explain these complications?
-Given that gum chewing was hypothesized to stimulate bowel motility and reduce
inflammation, it would be useful to discuss whether these mechanisms could have indirectly
influenced the risk of complications. For example, chewing gum could have led to improved
motility and better gut perfusion, reducing the incidence of bowel anastomosis leakage or
abdominal distension.
assistant