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 .
Core temperatures during major abdominal surgery in patients warmed with new circulating-water garment, forced-air warming, or carbon-fiber resistive-heating system
Purpose It has been reported that recently developed circulating-water garments transfer more heat than a forced-air warming system . The authors evaluated the hypothesis that circulating-water leg wraps combined with a water mattress better maintain intraoperative core temperature ≥36 ° C than either forced-air warming or carbon-fiber resistive heating during major abdominal surgery . Methods Thirty-six patients undergoing open abdominal surgery were r and omly assigned to warming with : ( 1 ) circulating-water leg wraps combined with a full-length circulating-water mattress set at 42 ° C , ( 2 ) a lower-body forced-air cover set on high ( ≈43 ° C ) , and ( 3 ) a carbon-fiber resistive-heating cover set at 42 ° C . Patients were anesthetized with general anesthesia combined with continuous epidural analgesia . The primary outcome was intraoperative tympanic-membrane temperature ≥36 ° C . Results In the 2 h after anesthesia induction , core temperature decreased 1.0 ± 0.5 ° C in the forced-air group , 0.9 ± 0.2 ° C in the carbon-fiber group , and 0.4 ± 0.4 ° C in the circulating-water leg wraps and mattress group ( P < 0.05 vs. forced-air and carbon-fiber heating ) . At the end of surgery , core temperature was 0.2 ± 0.7 ° C above preoperative values in the circulating-water group but remained 0.6 ± 0.9 ° C less in the forced-air and 0.6 ± 0.4 ° C less in the carbon-fiber groups ( P < 0.05 vs. carbon fiber ) . Conclusions The combination of circulating-water leg wraps and a mattress better maintain intraoperative core temperature than did forced-air and carbon-fiber warming systems
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 .