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 .
Role of Somatostatin in the Prevention of Pancreatic Stump-related Morbidity following Elective Pancreaticoduodenectomy in High-risk Patients and Elimination of Surgeon-related Factors: Prospective, Randomized, Controlled Trial
A prospect i ve , r and omized , controlled trial was performed to determine the efficacy of somatostatin in the prevention of pancreatic stump-related complications with elimination of surgeon-related factors in high-risk patients undergoing panceaticoduodenectomy . From August 1997 to December 2000 , 54 patients , 28 men and 26 women , with age ranged from 32 to 89 years , were r and omly assigned to somatostatin group ( n = 27 ) or placebo group ( n = 27 ) . Ninety-four percent of the patients had pancreatic and periampullary lesions ; 6 % had secondary lesion involving the duodenum such as local recurrent colon carcinoma and renal cell carcinoma . These patients received either st and ard pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy . An experienced surgeon performed all operations in same fashion to minimize the surgical factor . A transanastomotic tube was inserted into the pancreatic duct for diversion of pancreatic juice in the pancreaticojejunostomy for a 3-weeks period postoperatively . Intravenous infusion of somatostatin was given at a dose of 250μg/hr in the somastotatin group and normal saline was given to the control group for 7 days postoperatively . There was one perioperative death in each group , result ing in a 3.7 % mortality rate . In the somastotatin group , as compared to the placebo group , the incidence of overall morbidity and pancreatic stump related complications were significantly lower with a mean decrease of 50 % pancreatic juice output and a slightly shorter duration of hospital stays . In conclusion , after excluding surgeon related factor , prophylactic use of somatostatin  reduces the incidence and severity of pancreatic stump related complications in high-risk patients having pancreaticoduodenectomy via decreased secretion of pancreatic exocrine
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 .