In patients undergoing colonic surgery within ERAS® program, an earlier recovery and consequently shorter hospital length of stay was registered [12, 13]. Furthermore, a reduction of postoperative morbidity in patients undergoing intestinal resection was reported too [14]. These results stimulated liver surgeons of the ERAS® group (Maastricht, Edinburgh, and Tromsö) to adapt the ERAS program to patients undergoing open liver resection. Van Dam et al. [15] prospectively collected data from 61 ERAS patients and compared them with a historical series of 100 patients: patients belonging to the first group were able to drink fluids after 4 h from surgery and eat normally on the day after the operation; furthermore, patients were independently mobile after 3 days and were therefore discharged after a median of 5 days, reducing length of stay from 8 to 6 days (25 %), without any negative effect on surgical safety. Authors even postulated that a further reduction of stay could be achievable, given the delay between functional recovery and discharge. The explanation of this delay is often linked to social problems, problems in home care support, or logistic problems.

Stoot et al. [16] investigated the additional value of laparoscopy in the context of enhanced recovery programs and reported retrospectively a further reduction in length of stay from 7 to 5 days when patients were operated laparoscopically and managed within an ERAS program, even confirming the delay between recovery and actual discharge of the patients. Furthermore the same authors reported a reduced blood loss in ERAS group that could be explained both to fast-track principles of low central venous pressure and avoidance of excessive fluid administration and to learning curve acquisition by operating surgeons.