Open AccessGuidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations
Author(s) -
Melloul Emmanuel,
Hübner Martin,
Scott Michael,
Snowden Chris,
Prentis James,
Dejong Cornelis H. C.,
Garden O. James,
Farges Olivier,
Kokudo Norihiro,
Vauthey JeanNicolas,
Clavien PierreAlain,
Demartines Nicolas
Publication year - 2016
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-016-3700-1
Subject(s) - medicine , jadad scale , colorectal surgery , abdominal surgery , randomized controlled trial , vascular surgery , medline , perioperative , cardiothoracic surgery , evidence based medicine , cardiac surgery , surgery , general surgery , intensive care medicine , alternative medicine , pathology , political science , law , cochrane library
Background 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. Methods 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. Results 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. Conclusions 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.