Postoperative management significantly determines the short- and long-term outcome of our patients. As the rate of intraoperative deaths declined dramatically since the late 1940s, the focus changed toward optimization of perioperative management [1]. To the same extent as inadequate management can ruin a primary textbook outcome, an optimized management can compensate for adverse pre- or intraoperative conditions.

This special issue of Visceral Medicine deals with different aspects of postoperative management bringing together experts in the fields of surgery, gastroenterology, infectiology, microbiology, anesthesia, and interventional radiology. Only close interdisciplinary discussion and treatment lead to the best possible outcome for our patients.

As protocols are criticized for being difficult to implement, the question for more tailor-made approaches arises. Seyfried et al. [2] have critically revised the current literature to answer this question. In their article, they explain why ERAS® can be followed by almost all patients but can only work in the totality of its tools. A tailored program outside of disease-specific pathways does not seem to be useful. Prehabilitation is more adaptive and can also increase adherence to ERAS® protocols.

Drefs et al. [3] report on different endoscopic treatment options for postoperative gastrointestinal leaks. As reported here, endoscopic vacuum therapy (EVT) has become the mainstay of therapy for upper as well as lower GI defects. Out of all available endoscopic options, EVT appears to have gained the most evidence and shows the highest success rates. New aspects of EVT such as preemptive application and ambulatory use are also discussed.

The endoscopic accessibility of the postoperative situs can be very challenging. Especially after hepatobiliary or upper gastrointestinal resection/reconstruction, it is uncertain if the region of interest can be reached endoscopically or if other interventional options should be given advantage. Aulinger et al. [4] describe in their article the feasibility of novel techniques including endosonography-directed approaches, overtube-assisted approaches, or spiral enteroscopy to reach the papilla or biliodigestive anastomosis in case of long limbs, percutaneous or even hybrid approaches.

Deniz and colleagues [5] report that postoperative management after complex and challenging visceral procedures in certified high-volume centers can benefit from an additional high expertise in interventional radiology. With the technical developments and advancements in minimally invasive procedures, interventional radiology provides a broad spectrum of procedures in the management of patients with postoperative complications such as bleeding, vascular stenoses, or abscess formations.

The increase in multidrug-resistant bacteria poses additional challenges for abdominal surgery. The review article by Obst et al. [6] summarizes the current recommendations for antimicrobial prevention, for anti-infective therapy of postoperative peritonitis and surgical site infections and highlights the importance of an AMS program in abdominal surgery.

Nutrition management is one of the determining factors for postoperative outcome. Wobith and Weimann [7] answer the question: “Postoperative nutrition management – Who needs what?” very clearly and comprehensibly. The authors explain, why especially in cancer patients, malnutrition may be inapparent at the time of surgery. As malnutrition is a well-known risk factor in patients undergoing abdominal surgery, they give also straightforward recommendations for additional nutrition during prehabilitation.

Finally, the interdisciplinary discussion article [8] highlights different aspects of postoperative management and gives recommendations based on data availability and personal experience. The guest editors would like to express their gratitude to all the authors involved in this special journal issue on postoperative management and the journal’s editorial team for their great support.

The authors have no conflicts of interest to declare.

There was no funding for this editorial.

Florian Kühn and Christian Schulz contributed equally to this editorial.

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