Context The enhanced recovery after surgery pathway aims to reduce the stress related to surgery and thereby accelerate the recovery of patients. The experience of implementing this pathway in so called complex type pancreatic surgery is relatively limited. Objective The aim of this study was to evaluate the safety, feasibility and clinical outcomes of the ERAS protocol after pancreatic resection at B P Koirala Institute of Health Sciences (BPKIHS), Nepal. Methods Between December 2015 to January 2018, a retrospective analysis of 25 consecutive patients managed by enhanced recovery after surgery protocol following pancreatic resection was carried out. The incidences of postoperative complications, postoperative length of hospital stay, readmissions, reoperations and mortality were studied. Results A total of 25 patients who underwent pancreatic resection (pancreaticoduodenectomy-64%, distal pancreatectomy-20% and Frey’s procedure-16%) were analyzed. The mean age of the patients was 48 years with a female predominance (56%). Jaundice was seen in 48% of patients, while preoperative biliary drainage was required in only 12% of cases. The mean postoperative length of hospital stay and overall morbidity were 10.8 days and 60% respectively, with major morbidity as per Clavien-Dindo classification was seen in only 24% of patients, which were in accordance with the existing world literature. Similarly, the 30-day reoperation, readmission and mortality rates were 12%, 4% and 4% respectively. Conclusion The enhanced recovery after surgery protocol is feasible and should be valued and adopted in the management of pancreatic pathologies at our centre.
Narendra Pandit, Rupesh Sah, Laligen Awale, Lokesh Shekher Jaiswal, Shailesh Adhikary