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 .
Influence of Food Intake on the Healing Process of Postoperative Pancreatic Fistula After Pancreatoduodenectomy: A Multi-institutional Randomized Controlled Trial
Background The usefulness of enteral nutrition via a nasointestinal tube for patients who develop postoperative pancreatic fistula ( POPF ) after miscellaneous pancreatectomy procedures has been reported . However , no clear evidence regarding whether oral intake is possible during management of POPF after pancreatoduodenectomy ( PD ) is currently available . We investigated the effects of oral food intake on the healing process of POPF after PD by a multi-institutional r and omized controlled trial . Methods Patients who developed POPF were r and omly assigned to the dietary intake ( DI ) group ( n = 30 ) or the fasted group [ no dietary intake ( NDI ) group ] ( n = 29 ) . The primary endpoint was the length of drain placement . Results No significant differences were found in the length of drain placement between the DI and NDI groups [ 27 ( 7–80 ) vs. 26 ( 7–70 ) days , respectively ; p = .8858 ] . POPF progressed to a clinical ly relevant status ( grade B/C ) in 20 patients in the DI group and 19 patients in the NDI group ( p = .9257 ) . POPF-related intra-abdominal hemorrhage was found in 2 patients in the NDI group , but in no patients in the DI group ( p = .1434 ) . There were no significant differences in POPF-related intra-abdominal hemorrhage , the incidence of other complications , or the length of the postoperative hospital stay between the 2 groups . Conclusion Food intake did not aggravate POPF and did not prolong the length of drain placement or hospital stay after PD . There may be no need to avoid oral dietary intake in patients with POPF
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 .