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| Improvement of gastric emptying by enhanced recovery after pancreaticoduodenectomy |
| Efstratios Zouros, Theodoros Liakakos, Anastasios Machairas, Paulos Patapis, Christos Agalianos and Christos Dervenis |
Athens, Greece
Author Affiliations: Department of Surgery, “Konstantopouleio” General Hospital, 3-5 Agias Olgas Str., 14233 Athens, Greece (Zouros E, Agalianos C and Dervenis C); First Department of Surgery, Laiko University Hospital, Ag. Thoma 17, 11527 Athens, Greece (Liakakos T); Third Department of Surgery, Attikon University Hospital, Rimini 1, 12462 Athens, Greece (Machairas A and Patapis P)
Corresponding Author: Efstratios Zouros, MD, Department of Surgery, “Konstantopouleio” (Agia Olga) General Hospital, 3-5 Agias Olgas Str., 14233 Athens, Greece (Tel: +30-213-2057539; Fax: +30-213-2057541; Email: stratiszouros@gmail.com) |
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Abstract BACKGROUND: Enhanced recovery after surgery (ERAS) has improved postoperative outcomes particularly in colorectal surgery. This study aimed to assess compliance with an ERAS protocol and evaluate its effect on postoperative outcomes in patients undergoing pancreaticoduodenectomy.
METHODS: Fifty patients who had received conventional perioperative management from 2005 to 2009 (conventional group) were compared with 75 patients who had received perioperative care with an ERAS protocol (fast-track group) from 2010 to 2014. Mortality, complications, readmissions and length of hospital stay were evaluated and compared in the groups.
RESULTS: Compliance with each element of the ERAS protocol ranged from 74.7% to 100%. Uneventful patients had a significant higher adherence to the ERAS protocol (87.5% vs 40.7%; P<0.001). There were no significant differences in demographics and perioperative characteristics between the two groups. Patients in the fast-track group had a shorter time to remove the nasogastric tube, start liquid diet and solid food, pass flatus and stools, and remove drains. No difference was found in mortality, relaparotomy, readmission rates and overall morbidity. However, delayed gastric emptying and length of hospital stay were significantly reduced in the fast-track group. The independent effect of the ERAS protocol in reducing delayed gastric emptying and length of hospital stay was confirmed by multivariate analysis.
CONCLUSION: ERAS pathway was feasible and safe in improving gastric emptying, yielding an earlier postoperative recovery, and reducing the length of hospital stay.
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2016, Vol. 15 
