Enhanced recovery after surgery protocol (Hepatectomy & Pancreatectomy)

Enhanced recovery after surgery protocol

HepatectomyPancreatectomy
No NGT insertedInserted for major hepatectomy only, remove on POD 1 regardless of outputInserted only for pancreatoduodenectomy, removed on POD 1 regardless of output
Surgical drainsAlways one drain for major hepatectomies, no drains for minorSingle drain after distal pancreatectomy, two drains (anterior and posterior to pancreatojejunostomy) after pancreatoduodenectomy
Drain managementDrain fluid bilirubin on PODs 1 and 3, remove on POD 3 if levels less than three times that of serumDrain fluid for amylase on PODs 1 and 3, remove on POD 3 if clinically well and amylase level < 1000
Urinary catheterRemove on POD 1Remove on POD 1
POD 1 dietClears with daily limit 1000 cc

Clears with daily limit 1000 cc (distal resections)

Clears with daily limit 500 cc (pancreatoduodenectomy)

POD 2 dietUnrestricted clearsUnrestricted clears for distal resections, 1000 cc limit per day in pancreatoduodenectomy patients
POD 3 dietUnrestricted solid dietUnrestricted 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 restrictionDecrease IV fluid rate by 25% every day, heplock IV when patient tolerates 1000 cc postoperative intake in 24 h with no signs of elevated creatinineDecrease 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.

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