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. 2023 Jan;47(1):11-34.
doi: 10.1007/s00268-022-06732-5. Epub 2022 Oct 30.

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

Gaëtan-Romain Joliat  1 , Kosuke Kobayashi  2 , Kiyoshi Hasegawa  2 , John-Edwin Thomson  3 , Robert Padbury  3 , Michael Scott  4   5 , Raffaele Brustia  6 , Olivier Scatton  7 , Hop S Tran Cao  8 , Jean-Nicolas Vauthey  8 , Selim Dincler  9 , Pierre-Alain Clavien  9 , Stephen J Wigmore  10 , Nicolas Demartines  11 , Emmanuel Melloul  1
Affiliations

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

Gaëtan-Romain Joliat et al. World J Surg. 2023 Jan.

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.

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Conflict of interest statement

Prof. Nicolas Demartines is implementation chair of the ERAS Society. The other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of the systematic review of the literature
Fig. 2
Fig. 2
Process of the modified Delphi method for the development of the present consensus ERAS guidelines for perioperative care for liver surgery
See this image and copyright information in PMC

Comment in

References

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