Fast-track recovery programme after pancreatico- duodenectomy reduces delayed gastric emptying

Abstract

A fast-track programme after PD improves gastric emptying and reduces postoperative stay.

Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

“…A meta-analysis of 5 RCTs (176 patients) World Data specifically addressing PONV after PD specifically have not been identified. One comparative (non-randomised) study [7] showed that an ERAS protocol with early mobilisation, metoclopramide and removal of nasogastric tube on day 1 or day 2 decreased the rate of postoperative nausea and vomiting. Until further documentation becomes available, the suggestions for patients undergoing colorectal surgery [3] [122].…”

“…Suprapubic catheterisation is superior to transurethral catheterisation if used for DGE is a specific problem after PD occurring in &10-25 % of patients [6,7,9,170]. It may be necessary to insert a nasojejunal feeding tube in a minority of patients.…”

“…The ERAS group has published evidencebased consensus recommendations for colorectal surgery [2,3]. Beneficial experiences with clinical pathway programmes after pancreaticoduodenectomy (PD, Whipple's procedure) have been published [4][5][6][7][8][9], but the reported series employed different protocols, or no prospective protocol at all [6]. A comprehensive consensus framework is presented on which to base a future protocol for optimal perioperative care after PD.…”

Fifty consecutive pancreatectomies without mortality

“…Thus, Berberat et al 8 , Balzano et al 23 and di Sebastiano et al 24 found an average hospital stay of 10, 13 and 10 days, respectively, in series of patients undergoing pancreatectomy. Postoperative fluid restriction, early oral intake and mobilization, effective analgesia and early removal of drains and catheters form, in general, the main recommendations suggested by these and other authors 8,[23][24][25] . While we agree with most of these measures, we do not practice fluid restriction, neither the early removal of abdominal drains.…”

Inter-device differences in monitoring for goal-directed fluid therapy

“…The results of this undertaking are the Enhanced Recovery After Surgery (ERAS) protocols we know today (Table 1). [2][3][4][5][6][7][8][9][10][11][12][13][14] All ERAS protocols typically share the following features:…”