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 .
Pylorus Resection Does Not Reduce Delayed Gastric Emptying After Partial Pancreatoduodenectomy: A Blinded Randomized Controlled Trial (PROPP Study, DRKS00004191)
Objectives : The aim of this study was to investigate the effect of pylorus resection on postoperative delayed gastric emptying ( DGE ) after  partial pancreatoduodenectomy ( PD ) . Background : PD is the st and ard treatment for tumors of the pancreatic head . Preservation of the pylorus has been widely accepted as st and ard procedure . DGE is a common complication causing impaired oral intake , prolonged hospital stay , and postponed further treatment . Recently , pylorus resection has been shown to reduce DGE . Methods : Patients undergoing PD for any indication at the University of Heidelberg were r and omized to either PD with pylorus preservation ( PP ) or PD with pylorus resection and complete stomach preservation ( PR ) . The primary endpoint was DGE within 30 days according to the International Study Group of Pancreatic Surgery definition . Results : Ninety-five patients were r and omized to PP and 93 patients to PR . There were no baseline imbalances between the groups . Overall , 53 of 188 patients ( 28.2 % ) developed a DGE ( grade : A 15.5 % ; B 8.8 % ; C 3.3 % ) . In the PP group 24 of 95 patients ( 25.3 % ) and in the PR group 29 of 93 patients ( 31.2 % ) developed DGE ( odds ratio 1.534 , 95 % confidence interval 0.788 to 2.987 ; P = 0.208 ) . Higher BMI , indigestion , and intraabdominal major complications were significant risk factors for DGE . Conclusions : In this r and omized controlled trial , pylorus resection during PD did not reduce the incidence or severity of DGE . The development of DGE seems to be multifactorial rather than attributable to pyloric dysfunction alone . Pylorus preservation should therefore remain the st and ard of care in PD . Trial Registration : German Clinical Trials Register
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 .