Initial experience with a multimodal enhanced recovery programme in patients undergoing liver resection


  • Preliminary results of this study were presented to the 27th Congress of the European Society of Clinical Nutrition and Metabolism, Brussels, Belgium, August 2005, the 7th World Congress of the International Hepato-Pancreatic-Biliary Association, Edinburgh, UK, September 2006, and the Annual Scientific Meeting of the Association of Surgeons of Great Britain and Ireland, Manchester, UK, November 2007

  • The Editors are satisfied that all authors have contributed significantly to this publication



Accelerated recovery from surgery has been achieved when patients are managed within a multimodal Enhanced Recovery After Surgery (ERAS) protocol. This study evaluated the benefit of an ERAS programme for patients undergoing liver resection.


The ERAS protocol of epidural analgesia, early oral intake and early mobilization was studied prospectively in a consecutive series of 61 patients. Outcomes were compared with those in a consecutive series of 100 patients who underwent liver resection before the start of the study. Endpoints were postoperative length of hospital stay, postoperative resumption of oral intake, readmissions, morbidity and mortality.


Fifty-six patients (92 per cent) in the ERAS group tolerated fluids within 4 h of surgery and a normal diet on day 1 after surgery. Median hospital stay, including readmissions, was 6·0 days compared with 8·0 days in the control group (P < 0·001). There were no significant differences in rates of readmission (13 and 10·0 per cent respectively), morbidity (41 and 31·0 per cent) and mortality (0 and 2·0 per cent) between ERAS and control groups.


The ERAS fast-track protocol is safe and effective for patients undergoing liver resection. It allows early oral intake, promotes faster postoperative recovery and reduces hospital stay. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.