Controversies on carrying out standardized enhanced recovery after surgery program in perioperative management of pancreaticoduodenectomy
Pancreaticoduodenectomy (PD) is one of the most complex procedures in the field of general surgery, which involves multiple anastomoses and has a high risk of complications such as pancreatic fistula, biliary fistula and abdominal infection, leading to a difficult perioperative management. The currently advocated and implemented surgical concepts of precision, minimal invasion and damage control have laid the foundation for the employment of enhanced recovery after surgery (ERAS). Although the international directive consensus and guidelines have been issued, there are still controversies concerning the use of ERAS program in perioperative management of PD in China. For carrying out the standardized ERAS protocols in perioperative management of PD, the authors discuss and classify several highly controversial subjects such as preoperative fasting time for food and water, timing for nasogastric tube and peritoneal drainage tube removal, and administration of postoperative somatostatin.