Journal of Gastrointestinal Surgery

, Volume 19, Issue 2, pp 387–399 | Cite as

Enhanced Recovery After Surgery Protocols for Open Hepatectomy—Physiology, Immunomodulation, and Implementation

  • Andrew J. Page
  • Aslam Ejaz
  • Gaya Spolverato
  • Tiffany Zavadsky
  • Michael C. Grant
  • Daniel J. Galante
  • Elizabeth C. Wick
  • Matthew Weiss
  • Martin A. Makary
  • Christopher L. Wu
  • Timothy M. PawlikEmail author
Review Article


There has been recent interest in enhanced-recovery after surgery (ERAS®) or “fast-track” perioperative protocols in the surgical community. The subspecialty field of colorectal surgery has been the leading adopter of ERAS protocols, with less data available regarding its adoption in hepato-pancreato-biliary surgery. This review focuses on available data pertaining to the application of ERAS to open hepatectomy. We focus on four fundamental variables that impact normal physiology and exacerbate perioperative inflammation: (1) the stress of laparotomy, (2) the use of opioids, (3) blood loss and blood product transfusions, and (4) perioperative fasting. The attenuation of these inflammatory stressors is largely responsible for the improvements in perioperative outcomes due to the implementation of ERAS-based pathways. Collectively, the data suggest that the implementation of ERAS principles should be strongly considered in all patients undergoing hepatectomy.


Enhanced recovery Hepatectomy Epidural anesthesia Low-CVP surgery 


Conflict of Interests

The authors declare no conflicts of interest with respect to the authorship and/or publication of this article.


The authors received no financial support for the research and/or authorship of this article.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2014

Authors and Affiliations

  • Andrew J. Page
    • 1
  • Aslam Ejaz
    • 1
  • Gaya Spolverato
    • 1
  • Tiffany Zavadsky
    • 1
  • Michael C. Grant
    • 2
  • Daniel J. Galante
    • 1
  • Elizabeth C. Wick
    • 1
  • Matthew Weiss
    • 1
  • Martin A. Makary
    • 1
  • Christopher L. Wu
    • 2
  • Timothy M. Pawlik
    • 1
    • 3
    Email author
  1. 1.Department of SurgeryJohns Hopkins HospitalBaltimoreUSA
  2. 2.Department of AnesthesiologyJohns Hopkins HospitalBaltimoreUSA
  3. 3.Department of SurgeryJohn L. Cameron Professor of Alimentary Tract SurgeryBaltimoreUSA

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