ERAS-protocol as described in low risk patients after pancreaticoduodenectomy or total pancreatectomy

Standard recovery protocol after pancreaticoduodenectomy or total pancreatectomy

Pancreatic Cancer

Surgery--Complications

Pancreatic Fistula

Delayed Gastric Emptying

Pancreatic Hemorrhage

First appointment:
- Enlightenment on the benefits and objectives of the ERAS protocol
Call to the patient day before the surgery:
Discussing the course, benefits and goals of care in ERAS 4 dl PreOp drink before bedtime
Operation day:
Fluid intake allowed 2 hours before surgery 2 dl PreOP drink 2 h before cutting

ERAS protocol preoperative actions

Intraoperative:
Drains in the peripancreatic or perihepatic regions are not set unless the surgeon sees this particular reason The nasogastric tube is removed at the end of the surgery

ERAS protocol intraoperative actions

Postoperatively:
Mobilization with nurses assisted Drinks allowed after 4h surgery
POP 1:
Drinking and normal food Removal of urinary catheter Intravenous liquids only if needed Mobilization Pain management by epidural cannula Discussion of the ERAS protocol Pancreatin capsules per os before eating
Postoperative day 2:
- Mobilization: As much as possible, autonomous movement
Postoperative day 3:
Ending epidural infusion cannula removal Mobilization as independently as possible
Pain relief: oxycodone/naloxone p.o. to keep mobilization possible:
Postoperative day 4:
Support and encouragement continues Pain management at a level that allows mobility

ERAS protocol postoperative actions

Tampere University Hospital Deparment of Gastroenterologic Surgery

ERAS Protocol in Pancreaticoduodenectomy and Total Pancreatectomy

Enhanced Recovery Versus Standard Recovery After Low-risk Pancreatoduodenectomy Identified With Acinar Cell Count or Total Pancreatectomy: a Randomized Controlled Trial

Time in days since the entry to hospital on the surgery day to the discharge day to follow up care or home

Time in days since the entry to hospital on the surgery day to the discharge day from the follow up care

Total number of postoperative complications

Number of readmissions in contrast to total patient number

Tampere University Hospital

Maintain nasogastric tube after extubation following pancreaticoduodenectomy

Remove nasogastric tube after extubation following pancreaticoduodenectomy

Vomiting

Nasogastric tube

No nasogastric tube

National taiwan University Hospital

Is Nasogastric Tube Necessary After Pancreaticoduodenectomy?

To compare the control and modified groups, all surgical complications will be further classified by severity using a novel grading system proposed by Dindo et al. In brief, grade I and II complications include only minor deteriorations from the normal postoperative course that can be treated with drugs, blood transfusion, physiotherapy, and nutritional supply. Grade III complications require interventional treatment. Grade IV complications are life-threatening and require intensive care unit management. Death is the only grade V complication. Grade I and II complications will be classified as minor and grades III, IV, and V will be classified as major.

National Taiwan University Hospital

The patients receiving pancreaticoduodenectomy will not undergo NG tube insertion before operation

The patients receiving pancreaticoduodenectomy will undergo NG tube insertion before operation

pancreatic fistula/nausea

ERAS Protocol in Pancreaticoduodenectomy and Total Pancreatectomy

Is Nasogastric Tube Necessary After Pancreaticoduodenectomy?

Is Nasogastric Tube Necessary After Pancreaticoduodenectomy?

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