Postoperative ileus is a common complication after major abdominal surgery. A positive effect of coffee to bowel movement has been described after colorectal and gynecologic interventions. The objective of this randomised controlled trial is to investigate whether the implementation of a fast track protocol with early coffee consumption accelerates the recovery of bowel function after pancreaticoduodenectomy.

Postoperative ileus (POI) is a common disorder after major abdominal surgery, affecting up to 40% of patients undergoing laparotomy. POI is described as the time between surgery and the first passage of flatus and/or stool and tolerance of oral diet. It could be recognised as postoperative complication when is defined as two or more of nausea/vomiting, inability to tolerate oral diet over 24 h, absence of flatus over 24 h, abdominal distention and radiologic confirmation on or after day 4 postoperatively without prior resolution. Multimodal approaches have been described to treat POI; among them, the early consumption of coffee showed a substantial benefit after colorectal and gynecologic surgery. The objective of this randomised trial is to investigate whether early coffee consumption can accelerate the recovery of bowel function after open pancreaticoduodenectomy.

Inclusion Criteria:

• Elective open pancreaticoduodenectomy
• Age ≥ 18 years
• American Society Anesthesiologists (ASA) score ≤ 3
• Ability of the subject to understand aims and clinical consequences of the trial
• Written informed consent

Exclusion Criteria:

• American Society Anesthesiologists (ASA) score ≥ 4
• Need for early postoperative Intensive Care Unit care
• Need for naso-gastric tube on postoperative day one
• Intolerance to coffee
• Refuse to assume coffee
• Pregnancy
• Surgical procedures performed different from pancreaticoduodenectomy
• Impaired mental status or language problems

Participants and staff were masked about the type of coffee administrated (standard coffee versus caffeine-free coffee). Masking about administration of hot water is not feasible.