title: Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations.
abstract: Enhanced Recovery After Surgery (ERAS) is a multimodal pathway developed to overcome the deleterious effect of perioperative stress after major surgery. In colorectal surgery, ERAS pathways reduced perioperative morbidity, hospital stay and costs. Similar concept should be applied for liver surgery. This study presents the specific ERAS Society recommendations for liver surgery based on the best available evidence and on expert consensus.
  
  
  
  A systematic review was performed on ERAS for liver surgery by searching EMBASE and Medline. Five independent reviewers selected relevant articles. Quality of randomized trials was assessed according to the Jadad score and CONSORT statement. The level of evidence for each item was determined using the GRADE system. The Delphi method was used to validate the final recommendations.
  
  
  
  A total of 157 full texts were screened. Thirty-seven articles were included in the systematic review, and 16 of the 23 standard ERAS items were studied specifically for liver surgery. Consensus was reached among experts after 3 rounds. Prophylactic nasogastric intubation and prophylactic abdominal drainage should be omitted. The use of postoperative oral laxatives and minimally invasive surgery results in a quicker bowel recovery and shorter hospital stay. Goal-directed fluid therapy with maintenance of a low intraoperative central venous pressure induces faster recovery. Early oral intake and mobilization are recommended. There is no evidence to prefer epidural to other types of analgesia.
  
  
  
  The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol.
authors.affiliation: Department of Visceral Surgery, University Hospital Lausanne, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.|Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, USA.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Melloul
authors.affiliation: Department of Visceral Surgery, University Hospital Lausanne, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
authors.affiliation: Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Scott
authors.affiliation: Department of Perioperative and Critical Care Medicine, Freeman Hospital, Newcastle upon Tyne, UK.|Institute of Cellular Medicine, The Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Snowden
authors.affiliation: Department of Perioperative and Critical Care Medicine, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: James
authors.initials: J
authors.lastname: Prentis
authors.affiliation: Department of Surgery, Maastricht University Medical Center and NUTRIM School for Translational Research in Metabolism, Maastricht, The Netherlands.
authors.forename: Cornelis H C
authors.initials: CH
authors.lastname: Dejong
authors.affiliation: Department of Clinical Surgery, School of Clinical Sciences, The University of Edinburgh, Edinburgh, UK.
authors.forename: O James
authors.initials: OJ
authors.lastname: Garden
authors.affiliation: Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Farges
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.affiliation: Department of Surgical Oncology, U.T. MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.affiliation: Swiss Hepato-pancreato-biliary and Transplantation Center, Department of Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
authors.affiliation: Department of Visceral Surgery, University Hospital Lausanne, CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland. demartines@chuv.ch.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
mesh_terms: D003697:Delphi Technique; D006801:Humans; D007902:Length of Stay; D008099:Liver / Q000601:surgery*; D019990:Perioperative Care / Q000379:methods; D017410:Practice Guidelines as Topic