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 .
Comparison of ramosetron and ondansetron for the treatment of established postoperative nausea and vomiting after laparoscopic surgery: a prospective, randomized, double-blinded multicenter trial
Background Postoperative nausea and vomiting ( PONV ) is a common complication after surgery , which increases physical and psychological discomfort and delays recovery . The aim of this study was to test the hypothesis that ramosetron is comparable to ondansetron for the treatment of established PONV after laparoscopic surgery using a prospect i ve , r and omized , double-blinded , noninferiority study . Methods Patients who had at least two risk factors of PONV and underwent laparoscopic surgery under general anesthesia were assessed for eligibility . Patients who developed PONV within the first 2 h after anesthesia received ondansetron ( 4 mg ) or ramosetron ( 0.3 mg ) intravenously in a r and omized double-blind manner . Patients were then observed for 24 h after drug administration . The incidence of nausea and vomiting , severity of nausea , rescue antiemetic necessity , and adverse effects at 0–2 or 2–24 h after drug administration was evaluated . The primary endpoint was the rate of patients exhibiting a complete response , defined as no emesis and no further rescue antiemetic medication for 24 h after drug administration . Results Among the 583 patients , 210 ( 36.0 % ) developed PONV and were r and omized to either the ondansetron ( n=105 ) or ramosetron ( n=105 ) group . Patient ’s characteristics were similar between the groups . The complete response rate was 44.1 % in the ondansetron group and 52.9 % in the ramosetron group after 24 h of initial antiemetic administration . The incidence of adverse events was not different between the groups . Conclusion We found evidence to support the noninferiority of ramosetron ( 0.3 mg ) compared to ondansetron ( 4 mg ) for the treatment of established PONV in moderate to high-risk patients undergoing laparoscopic surgery
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 .