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 .
Prospective randomized trial of the effect of octreotide on pancreatic juice output after pancreaticoduodenectomy in relation to histological diagnosis, duct size and leakage.
BACKGROUND Octreotide is generally administered based on the surgeon 's interpretation of perceived risk for pancreatic fistula at the time of pancreaticoduodenectomy ( PD ) . METHODS A single-institution , prospect i ve r and omized trial was conducted between April 2009 and December 2011 involving 62 PD patients who were r and omized to receive octreotide ( 100 μg subcutaneously every 8 h ; n = 32 ) or placebo ( n = 30 ) . Pancreatic juice output was measured after the operation using a catheter inserted into the pancreatic duct . Postoperative complications were recorded . RESULTS No significant differences in median output were found between the octreotide ( 82.5 ml ) and placebo ( 77.5 ml ) groups ( P = 0.538 ) . Median total output was significantly lower in patients with adenocarcinoma compared with those with periampullary tumours ( P = 0.004 ) and in patients with a duct diameter of > 5 mm compared with those with a duct diameter of < 5 mm ( P = 0.001 ) . There were no significant differences in overall morbidity between the octreotide and placebo groups ( P = 0.819 ) . Grade B pancreatic fistula ( International Study Group for Pancreatic Fistula ) was observed in two and three patients in the octreotide and placebo groups , respectively . CONCLUSIONS Morbidity did not differ significantly between the groups . This study did not demonstrate an inhibitory effect of octreotide on exocrine pancreatic secretion . Based on these results , the routine use of octreotide after PD can not be recommended
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 .