Beyond the procedure – current status of ERAS (enhanced recovery after surgery) in hepatobiliary and pancreatic surgery

Abstract Hepatobiliary and pancreatic surgery encompasses a field of highly complex procedures, causing relevant perioperative morbidity and mortality, even in specialized centers. Protocols for enhanced recovery after surgery (ERAS) aim to optimize the pre-, peri-, and postoperative courses to improve recovery quality and costs. In this short and comprehensive review, we discuss the current literature on ERAS protocols in hepatobiliary and pancreatic surgery, focusing mainly on articles published between 2024 and 2026. ERAS principles facilitate less postoperative complications and shorter hospital stays after hepatobiliary and pancreatic surgery, thus reducing costs related to longer hospitalization. In hepatic surgery, minimally invasive surgery is a key component of recent ERAS protocols, while in pancreatic surgery, there is still no recommendation for minimally invasive surgery in the ERAS protocol from 2019. Patients with liver cirrhosis represent an extremely vulnerable group when undergoing surgery and special items were presented to optimize ERAS protocols. In pancreatic surgery, advanced age and lack of fitness due to sarcopenia, cachexia, and malnutrition challenge postoperative recovery. However, despite reduction of complication rates and time of hospital stay, the implementation of ERAS programs in hepatobiliary and pancreatic surgery remains challenging, and the used protocols are highly heterogeneous. Further research will be needed to support the relevance of ERAS programs and develop new specific recommendations for high risk groups.