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 .
Intraoperative Fluid Restriction in Pancreatic Surgery: A Double Blinded Randomised Controlled Trial
Background Perioperative fluid restriction in a variety of operations has shown improvement of : complications , recovery of gastrointestinal function and length of stay ( LOS ) . We investigated effects of crystalloid fluid restriction in pancreatic surgery . Our hypothesis : enhanced recovery of gastrointestinal function . Methods In this double-blinded r and omized trial , patients scheduled to undergo pancreatoduodenectomy ( PD ) were r and omized : st and ard ( S:10ml/kg/hr ) or restricted ( R:5ml/kg/hr ) fluid protocol s. Primary endpoint : gastric emptying scintigraphically assessed on postoperative day 7 . Results In 66 r and omized patients , complications and 6-year survival were analyzed . 54 patients were analyzed in intention to treat : 24 S-group and 30 R-group . 32 patients actually underwent a PD and 16 patients had a palliative gastrojejunostomy bypass operation  in the full protocol analysis . The median gastric emptying time ( T½ ) was 104 minutes ( S-group , 95 % confidence interval : 74–369 ) versus 159 minutes ( R-group , 95 % confidence interval : 61–204 ) ( P = 0.893 , NS ) . Delayed gastric emptying occurred in 10 patients in the S-group and in 13 patients in the R-group ( 45 % and 50 % , P = 0.779 , NS ) . The primary outcome parameter , gastric emptying time , did not show a statistically significant difference between groups . Conclusion A fluid regimen of 10ml/kg/hr or 5ml/kg/hr during pancreatic surgery did not lead to statistically significant differences in gastric emptying . A larger study would be needed to draw definite conclusions about fluid restriction in pancreatic surgery . Trial registration IS RCT
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 .