Ann Surg Treat Res.  2018 Jul;95(1):7-15. 10.4174/astr.2018.95.1.7.

Meta-analysis of randomized controlled trials on the efficacy of daikenchuto on improving intestinal dysfunction after abdominal surgery

• Zhang L
• Cheng Y
• Li H
• Zhou Y
• Sun B
• Xu L

• KMID: 2414447
• DOI: http://doi.org/10.4174/astr.2018.95.1.7

Abstract

PURPOSE
Intestinal dysfunction is one of the most common complications in patients after abdominal surgery. Daikenchuto (DKT), a traditional herbal medicine, is recently employed to improve postoperative intestinal dysfunction. The aim of this meta-analysis was to assess the efficacy of DKT in improving intestinal dysfunction after abdominal surgery.
METHODS
PubMed, Embase, and the Cochrane library were systematically searched to identify randomized controlled trails (RCTs) in adult patients undergoing abdominal surgery, who were randomly distributed to administrate DKT and placebo. The primary outcomes included the time to first postoperative flatus or bowel movement. We used random-effects models to calculate summary mean differences (MDs) with 95% confidence intervals (CIs).
RESULTS
Nine RCTs totaling 1,212 patients (618 in DKT, 594 in control group) were included in our study. Compared with control group, DKT can effectively improve postoperative intestinal dysfunction by shortening the time to first postoperative flatus (MD, −0.41; 95% confidence interval [CI], −0.66 to −0.16; P = 0.001) with significant heterogeneity (I2 = 71%, P = 0.004), and bowel movement (MD, −0.65; 95% CI, −0.97 to −0.32; P < 0.001) without significant heterogeneity (I2 = 40%, P = 0.14). Sensitivity analyses by indication of surgery and type of surgery yielded similar results.
CONCLUSION
These data provide limited evidence that DKT shows efficacy on improving intestinal dysfunction after abdominal surgery. However, the results should be interpreted cautiously, due to the heterogeneity of the studies included. Thus, the efficacy of DKT on improving postoperative intestinal dysfunction warrants further investigation.

Keyword

Dai-kenchu-to; Abdominal surgery; Intestinal dysfunction; Meta-analysis; Randomized controlled trials

MeSH Terms

Adult
Flatulence
Herbal Medicine
Humans
Population Characteristics

Figure

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  Fig. 1 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of literature selection.

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  Fig. 2 Risk of bias: risk of bias in individual trials (A) and summary of brisk of bias of included studies (B). The grey and white represent “unclear risk of bias” and “low risk of bias” respectively.

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  Fig. 3 Meta-analysis comparing Daikenchuto (DKT) versus control group for the time to first postoperative flatus. SD, standard deviation; MH, MantelHaenszel; CI, confidence interval; IV, inverse variance.

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  Fig. 4 Meta-analysis comparing Daikenchuto (DKT) versus control group for the time to first postoperative bowel movement. SD, standard deviation; MH, MantelHaenszel; CI, confidence interval; IV, inverse variance.

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