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 .
The Value of Drains as a Fistula Mitigation Strategy for Pancreatoduodenectomy: Something for Everyone? Results of a Randomized Prospective Multi-institutional Study
Background A recent r and omized , controlled trial investigating intraperitoneal drain use during pancreatoduodenectomy ( PD ) had a primary goal of assessing overall morbidity . It was terminated early with findings that routine elimination of drains in PD increases mortality and the severity and frequency of overall complications . Here , we provide a follow-up analysis of drain value in reference to clinical ly relevant postoperative pancreatic fistula ( CR-POPF ) . Methods Nine institutions performed 137 PDs , with patients r and omized to intraperitoneal drainage ( N = 68 ) or no drainage ( N = 69 ) . The Fistula Risk Score ( FRS ) , a 10-point scale derived from four vali date d risk factors for CR-POPF , facilitated risk adjustment between treatment groups . Results There was no difference in fistula risk between the two cohorts . Overall , CR-POPF rates were higher in the no drain group compared to the drain group ( 20.3 vs. 13.2 % ; p = 0.269 ) . Patients with negligible/low FRS risk had higher rates of CR-POPF when drains were used ( 14.8 vs. 4.0 % ; p = 0.352 ) . Conversely , there were significantly fewer CR-POPFs ( 12.2 vs. 29.5 % ; p = 0.050 ) when drains were used with moderate/high risk patients . Lastly , moderate/high risk patients who suffered a CR-POPF had reduced 90-day mortality ( 22.2 vs. 42.9 % ) when a drain was used . Conclusion The results of this analysis suggest that drains diminish the rate and severity of CR-POPF in patients with moderate/high risk , but they could possibly be avoided in the roughly one third of patients with negligible/low risk
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 .