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Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022

ERAS Society · 2022 · international

Source and licence

Authors
Gaëtan-Romain Joliat, Kosuke Kobayashi, Kiyoshi Hasegawa et al.
Title
Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations 2022
Journal
World Journal of Surgery, 2022
DOI
10.1007/s00268-022-06732-5
Licence
CC BY 4.0
Changes
Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC9726826

Licence statement of the original publication

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.

Open the original publication →Full text on Europe PMC

Recommendations

We found no explicitly labelled recommendations in this publication; its recommendations are in the running text of the original.

Abstract

Background: Enhanced Recovery After Surgery (ERAS) has been widely applied in liver surgery since the publication of the first ERAS guidelines in 2016. The aim of the present article was to update the ERAS guidelines in liver surgery using a modified Delphi method based on a systematic review of the literature.

Methods: A systematic literature review was performed using MEDLINE/PubMed, Embase, and the Cochrane Library. A modified Delphi method including 15 international experts was used. Consensus was judged to be reached when >80% of the experts agreed on the recommended items. Recommendations were based on the Grading of Recommendations, Assessment, Development and Evaluations system.

Results: A total of 7541 manuscripts were screened, and 240 articles were finally included. Twenty-five recommendation items were elaborated. All of them obtained consensus (>80% agreement) after 3 Delphi rounds. Nine items (36%) had a high level of evidence and 16 (64%) a strong recommendation grade. Compared to the first ERAS guidelines published, 3 novel items were introduced: prehabilitation in high-risk patients, preoperative biliary drainage in cholestatic liver, and preoperative smoking and alcohol cessation at least 4 weeks before hepatectomy.

Conclusions: These guidelines based on the best available evidence allow standardization of the perioperative management of patients undergoing liver surgery. Specific studies on hepatectomy in cirrhotic patients following an ERAS program are still needed.

Supplementary Information: The online version contains supplementary material available at 10.1007/s00268-022-06732-5.

Contents of the original publication

The section headings of the original.

  • Introduction
  • Material and methods
  • Literature search and data selection
  • Inclusion and exclusion criteria
  • Quality assessment and grade of recommendation
  • Analyzed items
  • Modified Delphi method
  • Results
  • Preoperative counseling
  • Prehabilitation
  • Preoperative biliary drainage (PBD)
  • Preoperative smoking and alcohol cessation
  • Preoperative nutrition
  • Perioperative oral immunonutrition
  • Preoperative fasting and preoperative carbohydrate load
  • Pre-anesthetic medication
  • Anti-thrombotic prophylaxis
  • Preoperative steroids administration
  • Antimicrobial prophylaxis and skin preparation
  • Minimally invasive approach
  • Epidural, postoperative intravenous, and postoperative per oral analgesia
  • Wound catheter and transversus abdominis plane (TAP) block
  • Prophylactic nasogastric intubation
  • Prophylactic abdominal drainage
  • Preventing intraoperative hypothermia
  • Postoperative artificial nutrition and early oral intake
  • Postoperative glycemic control
  • Prevention of delayed gastric emptying (DGE)
  • Stimulation of bowel movement
  • Early and scheduled mobilization
  • Postoperative nausea and vomiting (PONV) prophylaxis
  • Fluid management
  • Monitoring/audit
  • Discussion

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