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Kumar et al. Mini-invasive Surg 2018;2:41 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.49

Review Open Access

Enhanced recovery after surgery in liver surgery

Niteen Kumar, Sandeep K. Jha, Sanjay Singh Negi

Department of HPB Surgery and Liver Transplant, BLK Superspeciality Hospital, New Delhi 110005, India.

Correspondence to: Sanjay Singh Negi, Department of HPB Surgery and Liver Transplant, BLK Superspeciality Hospital, New
Delhi 110005, India. Email: drsanjaynegi@gmail.com

How to cite this article: Kumar N, Jha SK, Negi SS. Enhanced recovery after surgery in liver surgery. Mini-invasive Surg
2018;2:41. http://dx.doi.org/10.20517/2574-1225.2018.49
Received: 8 Jul 2018 First Decision: 8 Oct 2018 Revised: 20 Nov 2018 Accepted: 22 Nov 2018 Published: 29 Nov 2018

Science Editor: Fernando Andrés Alvarez Copy Editor: Cui Yu Production Editor: Huan-Liang Wu

Abstract
Enhanced recovery after surgery (ERAS) or fast-track surgery protocols, have been implemented across surgical
fields with positive impact on outcomes. These protocols represent a standardized and evidence-based multimodal
perioperative strategy founded on a series of measures aiming to attenuate the physical and psychological stress
responses to surgical insults, and to potentiate the postoperative rehabilitation of patients. The successful adoption of
ERAS protocols in various specialties enabled its gradual acceptance in the complex field of liver surgery. Even though
many elements have been adapted especially from colorectal surgery, a few elements of ERAS protocol are unique
to liver surgery. The goals of enhanced recovery can be achieved with efforts beginning at the first interaction on
outpatient basis. Core elements of this multidisciplinary effort include pre-operative counseling, shortened preoperative
fasting, no pre-anesthetic medication, targeted antimicrobial prophylaxis and early withdrawal, preventing and
treating of postoperative nausea and vomiting, minimally invasive approaches, avoidance of postoperative nasogastric
decompression, preventing hypothermia, optimal perioperative fluid management, selective use of abdominal drains,
early urinary catheter removal, optimal pain control, early oral feeding and mobilization. The available evidence from
recent randomized controlled studies and meta-analyses comparing ERAS programs with traditional care in liver surgery
suggests that length of hospital stay is shortened without increasing morbidity, mortality or readmission rates.

Keywords: Liver surgery, hepatic surgery, enhanced recovery after surgery, fast track, enhanced recovery

INTRODUCTION
Surgery alters the body physiology and defense mechanisms resulting in a catabolic state with impaired
immunity, gut motility and respiratory physiology. These post-operative physiologic changes stem from
metabolic, inflammatory or immunological responses and are thought to be primarily responsible for
[1]
morbidity . Mechanistically, initiation of surgical stress response is primarily due to afferent nerve im-
© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
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