P1073 - SUCCESSFUL INTRODUCTION OF ERAS IN WHIPPLE OPERATION: WHAT IS REAL MINIMALLY INVASIVE SURGERY FOR PATIENTS?

P1073

SUCCESSFUL INTRODUCTION OF ERAS IN WHIPPLE OPERATION: WHAT IS REAL MINIMALLY INVASIVE SURGERY FOR PATIENTS?

T. Kaido^1,*, Y. Miyachi¹, A. Ninomiya¹

¹Surgery, St. Luke's International Hospital, Tokyo, Japan

Rationale: The introduction of ERAS into pancreaticoduodenectomy (PD), called Whipple Operation, has been thought difficult because of accompanying malnutrition, sarcopenia, aggressive surgery, and postoperative complications including postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE). In this study, we examined whether we could introduce ERAS into PD and achieve short postoperative hospital stay. Moreover, we would like to discuss “What is real minimally invasive surgery (MIS) for patients?”.

Methods: Preoperatively, we routinely assess patients’ muscle strength and nutritional conditions and perform exercise and nutritional intervention for patients with sarcopenia or malnutrition according to the data. Intraoperatively, we perform pancreatico-jejunostomy (modified Blumgart’s method) and gastro-jejunostomy preventing DGE. Postoperatively, early mobilization, early oral intake, and early drain removal are essential. We have implemented the above strategy since April 2020 and retrospectively examined its validity. Sixty-eight consecutive patients who underwent open PD were enrolled. We examined various surgical outcomes including postoperative hospital stay.

Results: There were 39 men and 29 women. The median age was 71 years. The preoperative diagnosis was pancreas head cancer in 24, distal bile duct cancer in 12 and so on. The median blood loss was 310 ml. Grade B POPF was found in 4 patients (6%). No DGE was found. The median postoperative hospital stay was 8 days. All patients returned to their own homes.

Conclusion: We could successfully introduce ERAS into Whipple operation and achieve short postoperative hospital stay. We think that this is “real MIS for patients”.

Disclosure of Interest: None declared