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 .
Reconsideration of Postoperative Oral Intake Tolerance After Pancreaticoduodenectomy: Prospective Consecutive Analysis of Delayed Gastric Emptying According to the ISGPS Definition and the Amount of Dietary Intake
Objective : A prospect i ve consecutive study was planned to evaluate the postpancreaticoduodenectomy ( PD ) oral intake tolerance .  The occurrence of delayed gastric emptying ( DGE ) , as defined by the International Study Group of Pancreatic Surgery ( ISGPS ) , and the amount of dietary intake were analyzed . The risk factors for low oral intake tolerance were additionally determined . Summary Background Data : The causation of DGE after PD is still unclear . Several possible factors have been discussed , such as reconstruction methods and other complications . However , none of them has followed the definition of ISGPS . Methods : Between 2003 and 2007 , 101 consecutive patients underwent PD-related surgery , and st and ard operative procedure was performed on 85 patients . Perioperative data were prospect ively collected in all patients , and the patient 's postoperative dietary intake was recorded for all meals until discharge . As an indicator of early postoperative oral intake tolerance , we added up the dietary intake from postoperative day 1 to 21 and called this value the total amount of dietary intake ( TDI ) . The postoperative outcomes were compared between non-DGE and DGE . The high-low of TDI values was also analyzed . Multivariate analysis for factors associated with the occurrence of DGE and TDI was performed . Results : The occurrence of DGE as defined by ISGPS was 42 % . The postoperative outcomes of DGE patients were significantly poor compared with those of non-DGE patients . TDI values were significantly low in DGE patients , and non-DGE patients with low TDI values showed a significantly extended duration of parenteral nutrition and postoperative hospitalization . Operative bleeding ( > 1,000 mL ) and pancreatic fistulas were likely to be associated with DGE occurrence . Gender ( women ) , BMI ( > 25 kg/m2 ) , postoperative intraabdominal infection , and DGE were significantly associated with low TDI values . Conclusions : The ISGPS definition of DGE seemed feasible for patient management . TDI values provided additional information for analyzing postoperative oral intake tolerance , especially when describing the differences among non-DGE patients . Substantial risk factors for low oral intake tolerance were high BMI , postoperative intraabdominal infection , and DGE
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 .