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 HYSLAR Trial: A Prospective Randomized Controlled Trial of the Use of a Restrictive Fluid Regimen With 3% Hypertonic Saline Versus Lactated Ringers in Patients Undergoing Pancreaticoduodenectomy
Objective : This study was design ed to determine whether the volume and type of fluid administered for pancreaticoduodenectomy impacts postoperative outcomes . Background : Three percent hypertonic saline ( HYS ) has been suggested as a means of reducing the volume of fluid required to sustain tissue perfusion in the perioperative period . Methods : Between May 2011 and November 2013 , patients undergoing pancreaticoduodenectomy were enrolled in an institutional review board – approved , single-center , prospect i ve , parallel , r and omized controlled trial ( NCT 01428050 ) , comparing lactated Ringers ( LAR ) ( 15 mL/kg/hr LAR intraoperation , 2 mL/kg/hr LAR postoperation ) with HYS ( 9 mL/kg/hr LAR and 1 mL/kg/hr HYS intraoperation , 1 mL/kg/hr HYS postoperation ) . Results : A total of 264 patients were r and omized . Demographic variables between groups were similar . The HYS patients had a significantly reduced net fluid balance ( 65 vs 91 mL/kg , P = 0.02 ) . The overall complication rate was reduced in the HYS group ( 43 % vs 54 % ) , with a relative risk of 0.79 [ 95 % confidence interval ( CI ) , 0.62–1.02 ; P = 0.073 ] , factoring stratification for pancreas texture . After adjustment for age and weight , the relative risk was 0.75 [ 95 % CI ( 0.58–0.96 ) ; P = 0.023 ] . The total number of complications was significantly reduced in the HYS group ( 93 vs 123 ) , with an incidence rate ratio of 0.74 [ 95 % CI ( 0.56–0.97 ) ; P = 0.027 ] . After adjustment for age and weight , the incidence rate ratio was 0.69 [ 95 % CI ( 0.52–0.90 ) ; P = 0.0068 ] . Reoperations , length of stay , readmissions , and 90-day mortality were similar between groups . Conclusions : A moderately restrictive fluid regimen with HYS result ed in a statistically significant 25 % reduction in complications when adjusted for age , weight , and pancreatic texture
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 .