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 .
Treatment of bacteriobilia decreases wound infection rates after pancreaticoduodenectomy.
BACKGROUND Although mortality following pancreaticoduodenectomy is decreasing , postoperative morbidity remains high . It was hypothesized that culture-directed treatment of bacteriobilia would decrease the incidence of infectious complications following pancreaticoduodenectomy . METHODS In a retrospective study of 197 pancreaticoduodenectomy patients , those in the control group ( n = 128 , 2005 - 2009 ) were given perioperative prophylactic antibiotics , whereas those in the  treatment group ( n = 69 , 2009 - 2011 ) were continued on antibiotics until intraoperative bile culture results became available . Patients with bacteriobilia received 10 days of antibiotic treatment , which was otherwise discontinued in patients without bacteriobilia . Various complication rates were compared using Fisher 's exact test for categorical variables , Wilcoxon rank sum test for ordinal variables , and a two- sample t-test for continuous variables . RESULTS Demographics , comorbidities , baseline clinical characteristics , and intraoperative and postoperative variables were similar between the two groups . There were higher incidences of elevated creatinine ( 19 % versus 4 % ; P = 0.004 ) and preoperative hyperglycaemia ( 18 % versus 7 % ; P = 0.053 ) in the control group . Fewer patients in the control group underwent preoperative biliary stenting ( 48 % versus 67 % ; P = 0.017 ) and intraperitoneal drains were placed at the time of resection more frequently in the control group ( 85 % versus 38 % ; P < 0.001 ) . Bacteriobilia was found in 59 % of patients . Treatment of bacteriobilia was associated with a decrease in the rate of postoperative wound infections ( 12 % in the control group versus 3 % in the treatment group ; P = 0.036 ) and overall complication severity score ( 1 in the control group versus 0 in the treatment group ; P = 0.027 ) . CONCLUSIONS Prolonged antibiotic therapy for bacteriobilia may decrease postoperative wound infection rates after pancreaticoduodenectomy . A r and omized prospect i ve trial is warranted to provide evidence to further support this practice
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 .