The Enhanced Recovery After Surgery (ERAS) guidelines for pancreaticoduodenectomy (PD), also known as theWhipple procedure, are evidence-based recommendations designed to optimize perioperative care, reducecomplications, and accelerate recovery. The ERAS Society first published guidelines for PD in 2012, with anupdate in 2019, incorporating the latest evidence and expert consensus. Below is a summary of keyrecommendations from the 2019 ERAS guidelines for PD, based on the best available evidence:
Key ERAS Recommendations for Pancreaticoduodenectomy (2019)
Preoperative Phase
Intraoperative Phase
Postoperative Phase
Outcomes and Compliance
Evidence and Methodology
Practical Considerations
Sources
The Enhanced Recovery After Surgery (ERAS) guidelines for liver surgery, updated in 2022 by the ERASSociety, aim to standardize perioperative care to reduce complications, shorten hospital stays, and enhancerecovery. These guidelines were developed using a modified Delphi method with 15 international experts and asystematic review of 7,541 manuscripts, resulting in 240 articles included to support 25 recommendation items.All items achieved consensus (>80% agreement) and are based on the Grading of Recommendations,Assessment, Development and Evaluations (GRADE) system. Below is a concise summary of keyrecommendations, including updates from the 2016 guidelines:
Key ERAS Recommendations for Liver Surgery
Preoperative Phase
Intraoperative Phase
Postoperative Phase
General Recommendations
Evidence and Impact
Special Considerations
Implementation
For detailed guidelines, access the full text at the ERAS Society website (erassociety.org) or the 2022 publication in World Journal of Surgery. Prospective studies are still needed to confirm the protocol’s clinical impact, particularly in complex cases like cirrhosis.
Pancreatic enzyme supplementation is often necessary after a pancreatectomy (partial or total removal of the pancreas) to address pancreatic exocrine insufficiency (PEI), which occurs when the pancreas no longer produces sufficient digestive enzymes to break down food. Below is a concise overview based on current medical understanding:
Drainage Yes 🆚 No
Endoscopic 🆚 Percutaneous
Plastic 🆚 Metal stent
Convered 🆚 Uncovered Metal Stent
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