Postoperative mortality and morbidity following hepatic resection are increased when bile peritonitis is present. The records of 51 consecutive patients undergoing hepatic lobectomy were reviewed. Fifteen patients (29%) suffered postoperative bile leaks, and 4 died of hepatic failure with peritonitis secondary to bacterial contamination of undrained bile. To study the effect of bile peritonitis on early hepatic regeneration and energy metabolism, bile peritonitis was produced in rats undergoing a 70% hepatectomy. The peak level of DNA synthesis was lower and delayed and the hepatic energy charge was lower during the 48 h following hepatectomy in rats with peritonitis than in control rats undergoing 70% hepatectomy only. We conclude that bile peritonitis induces hepatic failure following hepatectomy by impeding liver regeneration and energy metabolism, in addition to facilitating bacterial peritonitis.

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