Although fluid therapy in hepatic surgery affects the postoperative course and morbidity, there is a paucity of unequivocal guidelines in the literature as to which of three fluid strategies to use: liberal, restrictive or goal-directed. We performed a review of literature regarding fluid management strategies in major abdominal procedures, focusing on hepatic surgery. The quantity and quality of fluids infused perioperatively is often dependent on the preference of the physician, institutional experience and practices. A liberal fluid regimen carries the risk of impaired wound healing and prolonged ileus, furthermore in liver surgery it may increase blood loss. Restrictive fluid therapy is the mainstay of the anesthetic management in hepatic resections, keeping the central venous pressure low controls outflow from the liver and results in a decrease in intraoperative blood loss. In recent years, goal-directed fluid therapy ( GDFT), as a component of enhanced recovery pathways after surgery (ERAS) programs, has gained in popularity. It is based on the concept of hemodynamic optimization in order to ensure optimal tissue perfusion and oxygen delivery. Furthermore, a fluid infusion strategy should be individualized in terms of the unique pathophysiology of the patient (e.g. cirrhosis) and the specific requirements of the surgical technique (laparoscopic procedures). Controversy regarding often contradictory data, leaves the clinician at a loss as to which fluid strategy will best serve the patient. Therefore, it is imperative to design and conduct clinical trials in a homogenous group of patients to define the optimal type and amount of fluid for patients undergoing hepatic surgery
