The impact of pre-habilitation on post-operative complications in patients undergoing Whipple surgery

INTERVENTION: Intervention1: Prehabilitation augmented ERAS protocol: 1. Nutritional: High protein diet and specific diet chart to meet the required kcals 2. Psychological: One to one counseling along with relaxation exercises and JPRM 3. Physical exercise: Resistance exercise and aerobic and anaerobic exercise , with incentive spirometry for a duration of atleast 4 weeks Control Intervention1: ERAS: Standard ERAS protocol for pancreatico‐duodenectomy for CONDITION: Health Condition 1: C250‐ Malignant neoplasm of head of pancreas PRIMARY OUTCOME: To compare the length of stay in hospital, postoperative complications, and readmission rates ; between patients managed with Prehabilitation augmented ERAS and those receiving traditional ; ERAS care.Timepoint: At baseline, after 4 weeks and after 8 weeks SECONDARY OUTCOME: 1.To assess patient‐reported outcomes, such as pain scores, bowel function recovery, quality of life ; and emotional well‐being in the two groups. ; 2.To evaluate the cost‐effectiveness of the Prehabilitation augmented ERAS protocol in comparison ; to traditional ERAS pathways.Timepoint: At baseline, at 4 weeks & at 8 weeks INCLUSION CRITERIA: 1. Resectable periampullary carcinoma, carcinoma head of pancreas, duodenal adenocarcinoma within 2 cm of ampulla and distal cholangiocarcinoma requiring Pancreatico‐duodenectomy 2. Able to provide informed consent 3. ASA I / II patients