A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay .
Enhanced recovery after surgery ( ERAS ) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications , costs and hospital stay .
This concept has been applied for pancreatic surgery since the first published guidelines in 2012 .
This study presents the up date d ERAS recommendations for  pancreatoduodenectomy ( PD )  based on the best available evidence and on expert consensus .
Laparoscopic surgery for pancreatic neoplasms: the European association for endoscopic surgery clinical consensus conference
Background Introduced more than 20 years ago , laparoscopic pancreatic surgery ( LAPS ) has not reached a uniform acceptance among HPB surgeons . As a result , there is no consensus regarding its use in patients with pancreatic neoplasms . This study , organized by the European Association for Endoscopic Surgery ( EAES ) , aim ed to develop consensus statements and clinical recommendations on the application of LAPS in these patients . Methods An international panel of experts was selected based on their clinical and scientific expertise in laparoscopic and open pancreatic surgery . Each panelist performed a critical appraisal of the literature and prepared evidence -based statements assessed by other panelists during Delphi process . The statements were further discussed during a one-day face-to-face meeting followed by the second round of Delphi . Modified statements were presented at the plenary session of the 24th International Congress of the EAES in Amsterdam and in a web-based survey . Results LAPS included laparoscopic distal pancreatectomy ( LDP ) , pancreatoduodenectomy ( LPD ) , enucleation , central pancreatectomy , and ultrasound . In general , LAPS was found to be safe , especially in experienced h and s , and also advantageous over an open approach in terms of intraoperative blood loss , postoperative recovery , and quality of life . Eighty-five percent or higher proportion of responders agreed with the majority ( 69.5 % ) of statements . However , the evidence is predominantly based on retrospective case – control studies and systematic review s of these studies , clearly affected by selection bias . Furthermore , no r and omized controlled trials ( RCTs ) have been published to date , although four RCTs are currently underway in Europe . Conclusions LAPS is currently in its development and exploration stages , as defined by the international IDEAL framework for surgical innovation . LDP is feasible and safe , performed in many centers , while LPD is limited to few centers . RCTs and registry studies are essential to proceed with the assessment of LAPS
A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay .
Enhanced recovery after surgery ( ERAS ) pathways are now implemented worldwide with strong evidence that adhesion to such protocol reduces medical complications , costs and hospital stay .
This concept has been applied for pancreatic surgery since the first published guidelines in 2012 .
This study presents the up date d ERAS recommendations for  pancreatoduodenectomy ( PD )  based on the best available evidence and on expert consensus .