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 .
Factors associated with delayed gastric emptying after pancreaticoduodenectomy.
BACKGROUND The factors associated with  delayed gastric emptying ( DGE ) after a pancreaticoduodenectomy ( PD ) are not definitively known . METHODS From November 2011 through to May 2012 , data were prospect ively collected on 711 patients undergoing a pancreaticoduodenectomy or total pancreatectomy as part of the American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project . Bivariate and multivariate models were employed to determine the factors that predicted DGE . RESULTS In the 711 patients , the overall rate of DGE was 20.1 % . In a bivariate analysis , intra-operative factors such as pylorus-preservation ( 47.1 % versus 43.7 % , P = 0.40 ) , intra-operative drain placement ( 85.5 % , versus 85.1 % , P = 0.91 ) and an antecolic compared with a retrocolic gastrojejunostomy ( 60.1 % versus 65.1 % , P = 0.26 ) were not different between the DGE and no DGE groups . Pancreatic fistula formation ( 31.2 % versus 10.1 % ) , post-operative sepsis ( 21.7 % versus 7.0 % ) , organ space surgical site infection ( SSI ) ( 23.9 % versus 7.9 % ) , need for percutaneous drainage ( 23.0 % versus 10.6 % ) and reoperation ( 10.6 % versus 3.1 % ) were higher in patients with DGE ( P < 0.0001 ) . In a multivariable model , only pancreatic fistula , post-operative sepsis and reoperation were independently associated with DGE . DISCUSSION In this multicentre study , only post-operative complications were associated with DGE . Neither pylorus preservation nor route of enteric reconstruction ( antecolic versus retrocolic ) was associated with delayed gastric emptying
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 .