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 .
No Need for Routine Drainage After Pancreatic Head Resection: The Dual-Center, Randomized, Controlled PANDRA Trial (ISRCTN04937707)
Objective : This dual-center , r and omized , controlled , noninferiority trial aim ed to prove that omission of drains does not increase reintervention rates after pancreatic surgery . Background : There is considerable uncertainty regarding intra-abdominal drainage after pancreatoduodenectomy . Methods : Patients undergoing pancreatic head resection with pancreaticojejunal anastomosis were r and omized to intra-abdominal drainage versus no drainage . Primary endpoint was overall reintervention rate ( relaparotomy or radiologic intervention ) . Secondary endpoints were clinical ly relevant pancreatic fistula ( grade B/C ) , mortality , morbidity , and hospital stay . The planned sample size was 188 patients per group . Results : A total of 438 patients were r and omized . Forty-three patients ( 9.8 % ) were excluded because no pancreatic anastomosis was performed , and 395 patients ( 202 drain , 193 no-drain ) were analyzed . Reintervention rates were not inferior in the no-drain group ( drain 21.3 % , no-drain 16.6 % ; P = 0.0004 ) . Overall in-hospital mortality ( 3.0 % ) was the same in both groups ( drain 3.0 % , no-drain 3.1 % ; P = 0.936 ) . Overall surgical morbidity ( 41.8 % ) was comparable ( P = 0.741 ) . Clinical ly relevant pancreatic fistula ( grade B/C : drain 11.9 % , no-drain 5.7 % ; P = 0.030 ) and fistula-associated complications ( drain 26.4 % ; no drain 13.0 % ; P = 0.0008 ) were significantly reduced in the no-drain group . Operation time ( P = 0.093 ) , postoperative hemorrhage ( P = 0.174 ) , intra-abdominal abscess formation ( P = 0.199 ) , biliary leakage ( P = 0.382 ) , delayed gastric emptying ( P = 0.062 ) , burst abdomen ( P = 0.480 ) , wound infection ( P = 0.758 ) , and hospital stay ( P = 0.487 ) did not show significant differences . Conclusions : Omission of drains was not inferior to intra-abdominal drainage in terms of postoperative reintervention and superior in terms of clinical ly relevant pancreatic fistula rate and fistula-associated complications . There is no need for routine prophylactic drainage after pancreatic resection with pancreaticojejunal anastomosis
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 .