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 .
Randomized controlled trial of perioperative antimicrobial therapy based on the results of preoperative bile cultures in patients undergoing biliary reconstruction
BACKGROUND The high frequency of surgical site infections ( SSIs )  after hepato-pancreato-biliary ( HPB ) surgery is a problem that needs to be addressed . This prospect i ve , r and omized , controlled study examined whether perioperative prophylactic use of antibiotics based on preoperative bile culture results in HPB surgery could decrease SSI . METHODS Participants comprised 126 patients who underwent HPB ( bile duct , gallbladder , ampullary , or pancreatic ) cancer surgery with biliary reconstruction at Hokkaido University Hospital between August 2008 and March 2013 ( UMIN Clinical Trial Registry # 00001278 ) . Before surgery , subjects were r and omly allocated to a targeted group administered antibiotics based on bile culture results or a st and ard group administered cefmetazole . The primary endpoint was SSI rates within 30 days after surgery . Secondary endpoint was SSI rates for each operative procedure . RESULTS Of the 126 patients , 124 were r and omly allocated ( targeted group , n = 62 ; st and ard group , n = 62 ) . Frequency of SSI after surgery was significantly lower in the targeted group ( 27 patients , 43.5 % ) than in the st and ard group ( 44 patients , 71.0 % ; P = 0.002 ) . Among patients who underwent pancreaticoduodenectomy and hepatectomy , SSI occurred significantly less frequently in the targeted group ( P = 0.001 and P = 0.025 , respectively ) . CONCLUSIONS This study demonstrated that preoperative bile culture-targeted administration of prophylactic antibiotics decreased SSIs following HBP surgery with biliary reconstruction
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 .