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 .
Determinants of Surgical Site Infections Following Pancreatoduodenectomy
Background Surgical site infections ( SSI ) following pancreatoduodenectomy ( PD ) contribute to adverse perioperative and long-term outcomes . Hence , the need to determine the modifiable factors related to their causation . Aim To identify demographic , nutritional , surgical and histopathological factors significantly associated with incisional SSIs . Methods A retrospective analysis of a prospect ively maintained data base of consecutive patients who underwent PD for pancreatic and periampullary lesions at a tertiary care referral centre , between April 2010 and June 2014 was carried out . Patients were divided into two groups based on the SSIs ( Group 1—With SSI ; Group 2—No SSI ) . All patients were administered three , once daily doses of Ertapenem ( 1 g ) as follows : within 1 h prior to induction , and on day 1 and day 2 following surgery . No further antibiotics were given prior to discharge unless clinical ly indicated . Results 35 out of 277 patients ( 12.6 % ) developed SSIs . No demographic ( age , sex , BMI ) , nutritional ( serum albumin ) , surgical ( pancreatic duct size and texture , surgical duration and intraoperative blood transfusions ) and histopathological factors ( malignancy vs. benign ) were noted between the two groups . However , SSIs were significantly higher in patients with endocrine co-morbidities ( other than diabetes mellitus ) , in those patients who had undergone prior ERCP and stenting , as well as an end-to-side pancreaticojejunostomy . Patients with diabetes mellitus had a significantly lower incidence of wound infections ( P = .014 ) . Conclusion Preoperative ERCP and stenting , end-to-side PJ and the presence of non-diabetic endocrine co-morbidity may result in a significantly higher risk of SSIs . Further studies targeting these patient sub population s are warranted to enable a better underst and ing of how these factors contribute to the incidence of SSIs following PD
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 .