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 Controlled Trial of Liberal Vs Restricted Perioperative Fluid Management in Patients Undergoing Pancreatectomy
Objective : The aim of this study is to examine , by a prospect i ve r and omized controlled trial , the influence of liberal ( LIB ) vs restricted ( RES ) perioperative fluid administration on morbidity  following pancreatectomy . Summary of Background Data : R and omized controlled trials in patients undergoing major intra-abdominal surgery have challenged the historical use of LIB fluid administration , suggesting that a more restricted regimen may be associated with fewer postoperative complications . Methods : Patients scheduled to undergo pancreatic resection were consented for r and omization to a LIB ( n = 164 ) or RES ( n = 166 ) perioperative fluid regimen . Sample size was design ed with 80 % power to decrease Grade 3 complications from 35 % to 21 % . Results : Between July 2009 and July 2015 , we r and omized 330 patients undergoing pancreaticoduodenectomy ( PD , n = 218 ) , central ( n = 16 ) , or distal pancreatectomy ( DP , n = 96 ) . Patients were equally distributed for all demographic and intraoperative characteristics . Intraoperatively , LIB patients received crystalloid 12 mL/kg/h and RES patients 6 mL/kg/h . Cumulative crystalloid given ( median , range , mL ) days 0 to 3 was LIB : 12,252 ( 6600 to 21,365 ) , RES 7808 ( 2700 to 16,274 ) P < 0.0001 . Sixty-day mortality was 2 of 330 ( 0.6 % ) . Median operative time for PD was 227 minutes ( 105 to 462 ) and DP 150 ( 44 to 323 ) . Grade 3 complications occurred in 20 % of LIB and 27 % of RES patients ( P = 0.6 ) . Median length of stay was 7 and 5 days for PD and DP , respectively , in both arms . Conclusions : In a high volume institution , major perioperative complications from pancreatic resection were not significantly influenced by fluid regimens that differed approximately 1.6-fold
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 .