The Effect of Simethicone on the Length of Hospital Stay of Patients Undergoing Laparotomy for Benign Gynecological Procedures with an Enhanced Recovery after Surgery Protocol: A randomized controlled trial

Abstract

Objectives: To evaluate the efficacy of simethicone in treating postoperative ileus symptoms assessed by length of hospital stay, for patients undergoing elective laparotomy for benign gynecological procedures in the setting of an enhanced recovery after surgery (ERAS) protocol and to identify factors associated with a decreased length of hospital stay. Materials and Methods: A single-center randomized controlled trial (TCTR20210204012) was conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand, between February and June 2021. In all, 182 patients were randomized into 2 groups: an "immediate-simethicone-administration-group" (administered 160 mg of simethicone immediately after surgery; n = 91) and a "non-immediate-simethicone-administration-group" (no immediate simethicone used; n = 91). The lengths of stay and other hospital data were analyzed. Results: No significant difference was observed in the lengths of stay of the immediate-simethicone-administration and non-immediate-simethicone-administration groups (p = 0.132), nor in their incidences of postoperative nausea/vomiting, abdominal discomfort, and diarrhea. A multivariate analysis found that the significant predictor of a decreased length of hospital stay was an estimated blood loss of < 500 mL (odds ratio 5.82, 95% confidence interval 1.20, 28.16, p = 0.029). Conclusion: Immediately chewing simethicone after surgery had no effect on the length of hospital stay in cases of benign laparotomy for gynecological procedures in the setting of an ERAS protocol. An estimated blood loss below 500 mL was a predictor of early hospital discharge.