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 .
Prophylactic octreotide and delayed gastric emptying after pancreaticoduodenectomy: results of a prospective randomized double-blinded placebo-controlled trial.
AIMS To evaluate the impact of prophylactic octreotide on gastric emptying in patients undergoing pancreaticoduodenectomy . Postoperative pancreatic fistula ( POPF ) and delayed gastric emptying ( DGE ) are common complications after pancreaticoduodenectomy . Whereas several prospect i ve r and omized trials propose the prophylactic use of octreotide to prevent pancreatic fistula formation , somatostatin has , however , been associated with delayed gastric emptying after partial duodenopancreatectomy . METHODS In this prospect i ve , r and omized , double-blinded , placebo-controlled trial we analyzed the influence of prophylactic octreotide on delayed gastric empting after pancreaticoduodenectomy . Patients were r and omized to the placebo group ( n=32 ) and the octreotide group ( n=35 ) . Primary endpoint was the incidence of delayed gastric emptying , secondary endpoints included perioperative morbidity other than DGE . DGE was measured by clinical signs , gastric scintigraphy and the hydrogen breath test . Risk factors for DGE other than octreotide were analyzed by univariate and multivariate analyses . RESULTS DGE measured by clinical signs was similar between both groups studied ( approximately 20 % of the patients ) . Gastric scintigraphy ( T(1/2 ) ) was 76.3+/-15.2 min in the octreotide group and 86.7+/-18.0 min in controls at day 7 , respectively . The H(2 ) breath test was 65.0+/-6.5 min in octreotide treatment group and 67.0+/-5.7 min in controls at day 8 . POPF grade C occurred in approximately 3 % of the patients , although prophylactic treatment of octreotide did not reduce the incidence of POPF . Multivariate analysis showed that postoperative intraabdominal bleeding and infection were independent risk factors for DGE . Furthermore preoperative biliary stenting reduced postoperative DGE after partial duodenopancreatectomy . CONCLUSION Prophylactic octreotide has no influence on gastric emptying and does not decrease the incidence of postoperative pancreatic fistula after pancreaticoduodenectomy
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 .