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 .
Routine nasogastric suction may be unnecessary after a pancreatic resection.
BACKGROUND Most surgeons routinely place a nasogastric tube at the time of a pancreatic resection . The goal of the present study was to evaluate the outcome when a pancreatic resection is performed without routine post-operative nasogastric suction . METHODS One hundred consecutive patients underwent a pancreatic resection ( 64 a pancreaticoduodenectomy , 98 % pylorus sparing and 36 a distal pancreatectomy ) . In the first cohort ( 50 patients ) , a nasogastric tube was routinely placed at the time of surgery and in the second cohort ( 50 patients ) the nasogastric was removed in the operating room . Outcomes for these two cohorts were recorded in a prospect i ve data base and compared using the χ(2 ) or Fisher 's exact test and Wilcoxon 's rank-sum test . RESULTS Demographical , surgical and pathological details were similar between the two cohorts . A post-operative complication occurred in 22 ( 44 % ) in each group ( P= 1.000 ) . There were no statistically significant differences in the frequency or severity of complications , or length of stay between groups . The spectrum of complications experienced by the two cohorts was similar including complications that could potentially be related to the use of nasogastric suction such as delayed gastric emptying , anastomotic leak , wound dehiscence and pneumonia . There was no difference between the two groups in the number of patients who required post-operative nasogastric tube placement ( or replacement ) [ 2 ( 4 % ) vs. 4 ( 8 % ) , P= 0.678 ] . CONCLUSION It may be safe to place a nasogastric tube post-operatively in a minority of patients after a pancreatic resection and spare the majority the discomfort associated with routine post-operative nasogastric suction
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 .