title: Feasibility of implementing fast-track surgery in pancreaticoduodenectomy with pancreaticogastrostomy for reconstruction--a prospective cohort study with historical control.
abstract: BACKGROUND
  Fast track programmes have been introduced in pancreatic surgery, but the data are sparse. The aim of this prospective study was to analyse the feasibility of implementing fast track rehabilitation protocol in PD with pancreaticogastrostomy, using historical control for comparison.
  
  
  METHODS
  Between April 2012 and December 2012, twenty patients who underwent PD (with pancreaticogastrostomy) were managed by a fast-track rehabilitation protocol. These patients were compared with an equal number of historical controls treated according to the traditional protocol.
  
  
  RESULTS
  Patients in the fast track group were able to tolerate liquid (p = 0.0005) and solid diet (p = 0.0001) earlier, and they passed stools earlier (p = 0.02). Delayed gastric emptying (DGE) was significantly reduced in the fast track group (p = 0.02). There was no difference in the rates of pancreatic fistula (PF), post pancreatectomy haemorrhage (PPH) and mortality between the two groups. Length of hospital stay was reduced in the fast track group (median 14 vs 18.5, p = 0.007).
  
  
  CONCLUSIONS
  Fast track programme appears to be feasible in PD, even with pancreatico-gastric anastomosis. It is associated with early recovery, reduced DGE and reduced hospital stay.
authors.affiliation: Institute of Surgical Gastroenterology and Liver Transplantation, Government Stanley Medical College, Chennai 600001, India. Electronic address: a_sastha@yahoo.com.
authors.forename: Sastha Ahanatha
authors.initials: SA
authors.lastname: Pillai
authors.affiliation: Institute of Surgical Gastroenterology and Liver Transplantation, Government Stanley Medical College, Chennai 600001, India. Electronic address: prahari05@yahoo.com.
authors.forename: Ravichandran
authors.initials: R
authors.lastname: Palaniappan
authors.affiliation: Institute of Surgical Gastroenterology and Liver Transplantation, Government Stanley Medical College, Chennai 600001, India. Electronic address: anbu_77@yahoo.com.
authors.forename: Anbalagan
authors.initials: A
authors.lastname: Pichaimuthu
authors.affiliation: Institute of Surgical Gastroenterology and Liver Transplantation, Government Stanley Medical College, Chennai 600001, India. Electronic address: kkgisur@gmail.com.
authors.forename: Kamala Kannan
authors.initials: KK
authors.lastname: Rajendran
authors.affiliation: Institute of Surgical Gastroenterology and Liver Transplantation, Government Stanley Medical College, Chennai 600001, India. Electronic address: dr_jeswanth@yahoo.co.in.
authors.forename: Jeswanth
authors.initials: J
authors.lastname: Sathyanesan
authors.affiliation: Institute of Surgical Gastroenterology and Liver Transplantation, Government Stanley Medical College, Chennai 600001, India. Electronic address: stanleygastro@yahoo.com.
authors.forename: Manoharan
authors.initials: M
authors.lastname: Govindhan
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D005240:Feasibility Studies; D005260:Female; D005746:Gastric Emptying; D005774:Gastrostomy / Q000379:methods / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010185:Pancreatic Fistula / Q000453:epidemiology; D016577:Pancreaticoduodenectomy / Q000379:methods / Q000401:mortality / Q000534:rehabilitation*; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors
keywords: ERAS; Fast-track surgery; Pancreatic resection; Pancreaticoduodenectomy; Pancreaticogastrostomy; Whipple's procedure