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 .
Impact of the Reconstruction Method on Delayed Gastric Emptying After Pylorus-Preserving Pancreaticoduodenectomy: A Prospective Randomized Study
Background Delayed gastric emptying ( DGE ) is of considerable concern in patients undergoing pylorus-preserving pancreaticoduodenectomy ( PPPD ) . Prolonged hospital stay , increased cost , and decreased quality of life add on to interventions needed to treat DGE . This study was conducted to determine if performing duodenojejunostomy via the antecolic rather than the retrocolic route improved incidence of DGE . Methods Patients undergoing PPPD between April 2007 and November 2009 were r and omized for either antecolic or retrocolic reconstruction of the duodenojejunostomy .  DGE was then assessed by clinical criteria on postoperative day ( POD ) 10 . A paracetamol absorption test was also administered with a liquid meal , and serial plasma levels of intestinal peptides were measured . Results Overall , 64 patients were amenable for analysis : 36 in the antecolic group and 28 in the retrocolic group . The incidences of DGE on POD 10 were 17.6 and 23.1 % ( antecolic vs. retrocolic , respectively ) ( p = 0.628 ) . The two groups did not differ in regard to their median ( interquartile range ) postoperative hospital length of stay [ 13.0 ( 10.0–17.5 ) vs. 12.5 ( 11.0–17.0 ) days ; p = 0.446 ] , time to regular diet [ 5 ( 5–7 ) vs. 5 ( 4–6 ) days ; p = 0.353 ] , or morbidity ( 52.9 vs. 50.0 % ; p = 0.777 ) . The median length of nasogastric tube decompression was similar in the two groups [ 4 ( 3–7 ) vs. 3 ( 3–5 ) days ; p = 0.600 ] . Levels of paracetamol and glucagon-like peptide-1 were markedly decreased in patients with DGE . Conclusions Antecolic reconstruction after PPPD does not improve the occurrence/the incidence of DGE and is similar to retrocolic reconstruction with regard to secondary outcome parameters
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 .