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 .
Prospective Randomized Clinical Trial of the Value of Intraperitoneal Drainage After Pancreatic Resection
Objective To test the hypothesis that routine intraperitoneal drainage is not required after pancreatic resection . Summary Background Data The use of surgically placed intraperitoneal drains has been considered routine after pancreatic resection . Recent studies have suggested that for other major upper abdominal resections , routine postoperative drainage is not required and may be associated with an increased complication rate . Methods After informed consent , eligible patients with peripancreatic tumors were r and omized during surgery either to have no drains placed or to have closed suction drainage placed in a st and ardized fashion after pancreatic resection . Clinical , pathologic , and surgical details were recorded . Results One hundred seventy-nine patients were enrolled in the study , 90 women and 89 men . Mean age was 65.4 years ( range 23–87 ) . The pancreas was the tumor site in 142 ( 79 % ) patients , with the ampulla ( n = 24 ) , duodenum ( n = 10 ) , and distal common bile duct ( n = 3 ) accounting for the remainder . A pancreaticoduodenectomy was performed in 139 patients and a distal pancreatectomy in 40 cases . Eighty-eight patients were r and omized to have drains placed . Demographic , surgical , and pathologic details were similar between both groups . The overall 30-day death rate was 2 % ( n = 4 ) . A postoperative complication occurred during the initial admission in 107 patients ( 59 % ) . There was no significant difference in the number or type of complications between groups . In the drained group , 11 patients ( 12.5 % ) developed a pancreatic fistula . Patients with a drain were more likely to develop a significant intraabdominal abscess , collection , or fistula . Conclusion This r and omized prospect i ve clinical trial failed to show a reduction in the number of deaths or complications with the addition of surgical intraperitoneal closed suction drainage after pancreatic resection . The data suggest that the presence of drains failed to reduce either the need for interventional radiologic drainage or surgical exploration for intraabdominal sepsis . Based on these results , closed suction drainage should not be considered m and atory or st and ard after pancreatic resection
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 .