Background: Surgical liver diseases encompass a broad spectrum of traumatic, infectious, benign, and malignant conditions associated with substantial morbidity and mortality worldwide. Data on the epidemiology and management of these conditions in sub-Saharan Africa remain scarce, limiting evidence-based planning and resource allocation. Objective: To describe the epidemiological characteristics, diagnostic patterns, therapeutic approaches, and outcomes of surgical liver diseases managed in referral hospitals in Douala, Cameroon. Methods: We conducted a retrospective multicenter cohort study in four referral hospitals in Douala, Cameroon, including the Douala General Hospital, Douala Laquintinie Hospital, Douala Gyneco-Obstetric and Pediatric Hospital, and the Regional Hospital. Medical records of adult patients managed for surgical liver diseases between January 2012 and December 2021 were reviewed. Patients with incomplete records were excluded. Data regarding demographics, risk factors, clinical presentation, laboratory findings, treatment modalities, and outcomes were extracted and analyzed using descriptive and comparative statistics. Results: Between January 2012 and December 2021, 9,749 patients were admitted to the participating surgical departments. Of these, 162 patients were diagnosed with a surgical liver disease, corresponding to a hospital prevalence of 1.66%. After excluding seven records with incomplete data, 155 patients were included in the final analysis. The 31–40-year age group was the most represented, and males accounted for 69.7% of cases (male-to-female ratio: 2.35:1). Primary liver tumors were the most frequent diagnosis (35.5%), followed by hepatic metastases (30.3%), liver trauma (25.2%), liver abscesses (6.5%), and hepatic cysts (2.6%). Hypertension (14.3%), hepatitis C infection (11.0%), hepatitis B infection (8.4%), and alcohol consumption (49.4%) were the most common risk factors. Abdominal pain was the leading presenting symptom (83.