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 .
Perioperative Antibiotics Covering Bile Contamination Prevent Abdominal Infectious Complications After Pancreatoduodenectomy in Patients With Preoperative Biliary Drainage
Background Although bile contamination caused by preoperative biliary drainage ( PBD ) is a risk factor for infectious complications after pancreatoduodenectomy , the appropriate perioperative antibiotic regimen remains unclear . We evaluated a perioperative antibiotic strategy targeting bile contamination associated with PBD procedures for preventing abdominal infectious complications after pancreatoduodenectomy . Methods Consecutive patients ( n = 254 ) underwent pancreatoduodenectomy at a single center .  Perioperative antibiotics were mainly cefazolin in non-PBD cases ( n = 116 ) and cefozopran in internal-PBD cases ( n = 87 ) . They were based on preoperative bile cultures in 51 of the external-PBD cases . Intraoperative bile cultures were examined prospect ively . Morbidity and abdominal infectious complication rates were evaluated . Results The incidence of positive intraoperative bile cultures was significantly higher in the internal-PBD ( 85 % ) and external-PBD ( 90 % ) cases than in the non-PBD cases ( 26 % ) ( p < 0.001 ) . The 91 % susceptibility to cefazolin for non-PBD was significantly higher than the 61 % for internal-PBD or 45 % for external-PBD ( p < 0.001 ) . Overall morbidity rates ( 23 , 23 , and 25 % ) and abdominal infectious complications ( 13 , 17 , and 14 % ) did not differ among the non-PBD , internal-PBD , and external-PBD cases , respectively . Only susceptibility to perioperative antibiotics  of biliary microorganisms classified as resistant was a significant independent risk factor for abdominal infectious complications ( p = 0.003 ) . Conclusions A perioperative antibiotic strategy particular to PBD procedures is valid for covering biliary microorganisms during pancreatoduodenectomy . Perioperative antibiotics covering bile contamination may prevent abdominal infectious complications after pancreatoduodenectomy in patients with and without 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 .