One hundred forty-nine elective hepatic resections were performed during the 12 years from 1973 to 1984. Nineteen of these patients (12.8%) developed intraperitoneal septic complications after hepatectomy (IPSCH), of whom 13 died of liver failure. Perioperative variables associated with IPSCH were as follows: (1) right or extended right lobectomy, (2) age greater than 65, (3) operation time greater than 5 h, (4) blood loss at operation greater than 3000 g, and (5) post-operative bleeding, which required laparotomy for hemostasis. Improved outcome of IPSCH since 1981 coincided with the emergence of opportunistic pathogens. Survivors of IPSCH had been diagnosed earlier, all by culture of the subphrenic drainage, and all had a lower bilirubin level at the time of diagnosis. It is concluded that secure hemostasis and avoidance of tissue devitalization during hepatectomy are essential to reduce the incidence of IPSCH and that routine culture of the subphrenic drainage will improve the outcome of IPSCH.
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