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 .
Specific Antibiotic Prophylaxis Based on Bile Cultures Is Required to Prevent Postoperative Infectious Complications in Pancreatoduodenectomy Patients Who Have Undergone Preoperative Biliary Drainage
Background Preoperative biliary drainage ( PBD )  is associated with bacterial contamination of bile , but the effects of PBD on morbidity after pancreatoduodenectomy remain controversial . The aim of this study was to characterize bile contamination to develop successful specific antibiotic prophylactic strategies for pancreatoduodenectomy . Methods Ninety-one consecutive patients who underwent pancreatoduodenectomy for periampullary tumor were prospect ively evaluated .  Prophylactic antibiotics were selected based on preoperative bile cultures . Bile cultures and postoperative complications were compared in 46 patients who underwent PBD ( drainage group ) versus 45 patients who did not ( nondrainage group ) . Results The incidence of positive bile cultures was higher in the drainage group ( 78 % ) than in the nondrainage group ( 36 % ) ( P < 0.001 ) . In the drainage group , positive bile cultures were frequently polymicrobial ( 61 % ) and demonstrated resistance to several antibiotics , including cefazolin ( 83 % ) , cefmetazole ( 72 % ) , and cefpirome ( 64 % ) . Overall morbidity ( 30 % and 22 % ) and infectious morbidity ( 13 % and 11 % ) did not differ significantly between the drainage and nondrainage groups , respectively . Conclusions PBD had a notable influence on bile microbial contamination , including a higher rate of antibiotic resistance . Therefore , specific antibiotic prophylaxis based on bile culture is required for preventing infectious complications in pancreatoduodenectomy patients who undergo PBD
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 .