World Journal of Laparoscopic Surgery

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VOLUME 13 , ISSUE 1 ( January-April, 2020 ) > List of Articles

Original Article

Laparoscopic vs Open Drainage of Complex Pyogenic Liver Abscess

Mohamed M Mogahed, Ashraf A Zytoon, Basem Eysa, Mohamed Manaa, Wessam Abdellatif

Keywords : Laparoscopy, Open drainage, Pyogenic liver abscess

Citation Information : Mogahed MM, Zytoon AA, Eysa B, Manaa M, Abdellatif W. Laparoscopic vs Open Drainage of Complex Pyogenic Liver Abscess. World J Lap Surg 2020; 13 (1):11-15.

DOI: 10.5005/jp-journals-10033-1395

License: CC BY-NC 4.0

Published Online: 23-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Complex pyogenic liver abscess (CPLA) is a rare fatal disease if untreated. Complex pyogenic liver abscess is a multilocular abscess more than 5 cm in diameter. Pyogenic liver abscess (PLA) is mainly treated by percutaneous aspiration or drainage under antibiotic cover. Surgical drainage is indicated if interventional radiology fails, if ruptured, or if associated with biliary or intra-abdominal pathology. Laparoscopic drainage is a promising management option. Aim: To evaluate the safety and efficacy of laparoscopic drainage as a management of complex pyogenic liver abscesses in comparison to open surgical drainage. Materials and methods: Combined retrospective and prospective comparative study of 48 patients having complex PLA who were admitted to NHTMRI and managed by either laparoscopic drainage or open surgical drainage from January 2012 to January 2020 as regards results, complications, perioperative morbidity, mortality, and possible recurrence. Twenty-six patients were managed by open drainage, and 22 patients by laparoscopic drainage. Culture sensitivity of pus was done for all patients. Patients having small, solitary, and unilocular PLA that responded to antibiotic treatment or/and percutaneous drainage were excluded. All patients were subjected to full clinical assessment, laboratory investigations, ultrasonography, computed tomography, or magnetic resonance images for the abdomen and pelvis. Results: Forty-eight patients having complex PLA with a median age of 54.5 years were managed by either laparoscopic drainage (22 patients) or open surgical drainage (26 patients). The operation time and hospital stay were less, and oral feeding was started earlier in laparoscopic group. Wound infection was higher in open drainage group. Abscess recurrence occurred once in laparoscopic group and once in open surgery group, and both were successfully treated with percutaneous drainage. One laparoscopic operation was converted to open. Conclusion: Both laparoscopic and open surgical drainage of PLA are safe and effective. Laparoscopic drainage has less operative time, morbidity, and hospital stay; however, open drainage is considered the management of choice for patients with severe sepsis or failed percutaneous drainage.

  1. Chung YF, Tan YM, Lui HF, et al. Management of pyogenic liver abscesses—percutaneous or open drainage? Singapore Med J 2007;48(12):1158–1165.
  2. Wankg W, Lee WJ, Wei PL, et al. Laparoscopic drainage of pyogenic liver abscesses. Surg Today 2004;34(4):323–325. DOI: 10.1007/s00595-003-2709-x.
  3. Cioffi L, Belli A, Limongelli P, et al. Laparoscopic drainage as first line treatment for complex pyogenic liver abscesses. Hepatogastroenterology 2014;61(131):771–775.
  4. Bowers ED, Robison DJ, Doberneck RC. Pyogenic liver abscess. World J Surg 1990;14(1):128–132. DOI: 10.1007/BF01670563.
  5. Aydin C, Piskin T, Sumer F, et al. Laparoscopic drainage of pyogenic liver abscess. JSLS 2010;14(3):418–420. DOI: 10.4293/108680810X12924466006567.
  6. Bächler P, Baladron MJ, Menias C, et al. Multimodality imaging of liver infections: differential diagnosis and potential pitfalls. Radiographics 2016;36(4):1001–1023. DOI: 10.1148/rg.2016150196.
  7. Lin AC, Yeh DY, Hsu YH, et al. Diagnosis of pyogenic liver abscess by abdominal ultrasonography in the emergency department. Emerg Med J 2009;26(4):273–275. DOI: 10.1136/emj.2007.049254.
  8. Benedetti NJ, Desser TS, Jeffrey RB. Imaging of hepatic infections. Ultrasound Q 2008;24(4):267–278. DOI: 10.1097/RUQ.0b013e31818e5981.
  9. Mortelé KJ, Segatto E, Ros PR. The infected liver: radiologic-pathologic correlation. Radiographics 2004;24(4):937–955. DOI: 10.1148/rg.244035719.
  10. Alsaif HS, Venkatesh SK, Chan DS, et al. CT appearance of pyogenic liver abscesses caused by Klebsiella pneumoniae. Radiology 2011;260(1):129–138. DOI: 10.1148/radiol.11101876.
  11. Doyle DJ, Hanbidge AE, O’Malley ME. Imaging of hepatic infections. Clin Radiol 2006;61(9):737–748. DOI: 10.1016/j.crad.2006.03.010.
  12. Huang CJ, Pitt HA, Lipsett PA, et al. Pyogenic hepatic abscess. Changing trends over 42 years. Ann Surg 1996;223(5):600–607. DOI: 10.1097/00000658-199605000-00016.
  13. Liu CH, Gervais DA, Hahn PF, et al. Percutaneous hepatic abscess drainage: do multiple abscesses or multiloculated abscesses preclude drainage or affect outcome? J Vasc Interv Radiol 2009;20(8):1059–1065. DOI: 10.1016/j.jvir.2009.04.062.
  14. Serraino C, Elia C, Bracco C, et al. Characteristics and management of pyogenic liver abscess: a European experience. Medicine (Baltimore) 2018;97(19):e0628. DOI: 10.1097/MD.0000000000010628.
  15. Malik AA, Bari SU, Rouf KA, et al. Pyogenic liver abscess: changing patterns in approach. World J Gastrointest Surg 2010;2(12):395–401. DOI: 10.4240/wjgs.v2.i12.395.
  16. Liu L, Chen W, Lu X, et al. Pyogenic liver abscess: a retrospective study of 105 cases in an emergency department from East China. J Emerg Med 2017;52(4):409–416. DOI: 10.1016/j.jemermed.2016.09.026.
  17. Tu JF, Huang XF, Hu RY, et al. Comparison of laparoscopic and open surgery for pyogenic liver abscess with biliary pathology. World J Gastroenterol 2011;17(38):4339–4343. DOI: 10.3748/wjg.v17.i38.4339.
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