Fermented liquid feed has been lately much investigated in order to compensate the use of antibiotics in pig production. The fermentation process has been claimed to be the reason of the benefits associated with this type of feeding. However, contradictory results have been obtained in feeding trials due to the variable conditions in each experiment. This review focuses on the different factors that would ensure a proper fermentation with all its beneficial effects. In particular, while fermenting a liquid diet with lactic acid bacteria has been shown to improve the quality of feed and to be beneficial to the health of the animals, spontaneously fermented liquid feed appears to be unsafe for the pigs and eventually affects the consumers' safety. Consequently, the use of specific starters or inoculants to ensure the proper fermentation could be a practical solution. The regulatory status of fermented liquid feed in the EU is still unclear, but the use of specific inoculants could be considered as a special case of microbial feed additives.