Enhanced recovery after surgery protocol (Hepatectomy & Pancreatectomy)

Enhanced recovery after surgery protocol

	Hepatectomy	Pancreatectomy
No NGT inserted	Inserted for major hepatectomy only, remove on POD 1 regardless of output	Inserted only for pancreatoduodenectomy, removed on POD 1 regardless of output
Surgical drains	Always one drain for major hepatectomies, no drains for minor	Single drain after distal pancreatectomy, two drains (anterior and posterior to pancreatojejunostomy) after pancreatoduodenectomy
Drain management	Drain fluid bilirubin on PODs 1 and 3, remove on POD 3 if levels less than three times that of serum	Drain fluid for amylase on PODs 1 and 3, remove on POD 3 if clinically well and amylase level < 1000
Urinary catheter	Remove on POD 1	Remove on POD 1
POD 1 diet	Clears with daily limit 1000 cc	Clears with daily limit 1000 cc (distal resections) Clears with daily limit 500 cc (pancreatoduodenectomy)
POD 2 diet	Unrestricted clears	Unrestricted clears for distal resections, 1000 cc limit per day in pancreatoduodenectomy patients
POD 3 diet	Unrestricted solid diet	Unrestricted solid diet for distal resections, unrestricted mechanical soft diet for pancreatoduodenectomy patients
Pain control adjuvants	Preoperative NSAIDS/gabapentin and TAP block Postoperative Tylenol/gabapentin once tolerates clears	Preoperative NSAIDS/gabapentin and TAP block Postoperative Tylenol/gabapentin once tolerates clears
Postoperative fluid restriction	Decrease IV fluid rate by 25% every day, heplock IV when patient tolerates 1000 cc postoperative intake in 24 h with no signs of elevated creatinine	Decrease IV fluid rate by 25% every day, heplock IV when patient tolerates 1000 cc postoperative intake in 24 h with no signs of renal dysfunction.

• NGT, nasogastric tube; NSAIDS, non‐steroidal anti‐inflammatory medications; POD, postoperative day; TAP, transverse abdominis plane.