Background : The aim of this prospective study was to investigate the feasibility of implementing an enhanced recovery after surgery (ERAS) program in patients undergoing Pancreatico-duodenectomy (Whipple procedure) at our institute and measure outcomes.

Methods : Patients undergoing Pancreatico-duodenectomy (Whipple procedure) were managed according to an ERAS protocol. Outcome measures included postoperative morbidity, mortality, and readmission rate. Key protocol targets were as follows: Preoperative ERAS protocol counseling, intraoperative goal-directed fluid therapy, maintaining normothermia, nasogastric tube (NGT) removal (Postoperative Day 1), resumption of feeding (Postoperative Day 1), urinary catheter removal (Postoperative Day 3), drain removal (Postoperative Day 5), and early hospital discharge (Postoperative Days 5-7).

Results : Data were collected for 25 patients. The proportions of patients achieving key targets were as follows: 88% for NGT removal on Postoperative Day 1; 76% for urinary catheter removal on Postoperative Day 3, 64% for drain removal on Postoperative Day 5, and 76% for tolerating an oral diet. The average duration of postoperative hospitalization was 6.52 days (range: 5-18). Pancreatic leak occurred in 20% (6 patients), of which 4 had biochemical leaks and 2 had Grade-B leaks. One patient had a chyle leak (Grade-B), and another had a Grade-B post-pancreatectomy hemorrhage (PPH). Six patients experienced delayed gastric emptying (4 Grade A, 1 Grade B, 1 Grade C). Two patients required readmission.

Conclusions : The ERAS protocol could be implemented safely in our center and does not seem to compromise surgical outcomes. The ERAS-based protocol shows promise for a shorter recovery time in patients undergoing Pancreaticoduodenectomy.