Published: 2021-01-29

Laparoscopic management of liver abscess: a viable alternative in USG guided percutaneous drainage failure cases

Nikhil Tak, Rajendra Bagree, Gaurav Jalendra, Hetish M. Reddy


Background: Liver abscesses are conventionally treated by ultrasonography (USG) guided percutaneous aspiration or drainage under antibiotic cover. We performed laparoscopic liver abscess drainage successfully in patients where medical management and percutaneous drainage had proven inadequate.

Methods: Cases were received either from outpatient department (OPD) or were transferred from medical wards. Patients were first treated conservatively and percutaneous aspiration was attempted. Patients not responding to these treatment modalities were considered for diagnostic laparoscopy with drainage of abscess cavity and placement of 28 Fr drain under vision.

Results: 20 patients with large liver abscess were treated successfully by laparoscopic drainage. Mean age in the study was 47 years (range 19-70 years) and average hospital stay was 5 days (range 4-12 days). Major postoperative morbidity or deaths were not registered. Patients with ruptured liver abscess, deep seated abscess cavity and medically unfit patients were excluded from the study.

Conclusions: Laparoscopic drainage of liver abscesses, in combination with systemic antibiotics is a safe and viable alternative in all patients who require surgical drainage. It helps in the early return of gastrointestinal function and resumption of normal activities also potentially achieving better abscess drainage.


Liver abscess, Laparoscopic drainage, USG guided percutaneous drainage

Full Text:



Mischnik A, Kern WV, Thimme R. Pyogenic liver abscess: Changes of Organisms and Consequences for Diagnosis and Therapy. Dtsch Med Wochenschr. 2017;142(14):1067-74.

Czerwonko ME, Huespe P, Bertone S, Pellegrini P, Mazza O, Pekolj J. Pyogenic liver abscess: current status and predictive factors for recurrence and mortality of first episodes. HPB (Oxford). 2016;18(12):1023-30.

Kaplan GG, Gregson DB, Laupland KB. Population-based study of the epidemiology of and the risk factors for pyogenic liver abscess. Clin Gastroenterol Hepatol. 2004;2(11):1032-8.

Hughes MA, Petri Jr WA. The Genuine Works of Hippocrates. Amoebic liver abscess. Infect Dis Clin North Am. 2000;14:565-82.

Hippocrates, Adams F. The Genuine Works of Hippocrates. New York: William Wood and co. 1886.

Zerem E, Hadzic A. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess. Am J Roentgenol. 2007;189(3):138-42.

Branum G, Tyson G, Branum M. Hepatic abscess changes in etiology, diagnosis and management. Ann Surg. 1990;212(6):655-6.

Dhamodharan SR, Christeena Indrani J. Int J Dent Med Sci Res. 2018;2(9):1-11.

Singh S, Chaudhary P, Saxena N, Khandelwal S, Poddar DD, Biswal UC. Treatment of liver abscess: Prospective randomized comparison of catheter drainage and needle aspiration. Ann Gastroenterol. 2013;26:332-9.

Ng SS, Lee JF, Lai PB. Role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy. World J Gastroenterol. 2008;14:747-51.

Dhir U, Ghuman SS, Singhri S. Caudate lobe liver abscess: early surgical drainage. J Liver Res Disord Ther. 2018;4(11):49-51.

Naseer AA, Walid M, Abd EM. Abscess of the caudate lobe of liver, a rare disease with a challenging management: a case report. J Biomedical Res. 2013;27(5);430-4.

Ferraioli G, Garlaschelli A, Zanaboni D, Gulizia R, Brunetti E, Tinozzi FP, et al. Percutaneous and surgical treatment of pyogenic liver abscesses: Observation over a 21-year period in 148 patients. Dig Liver Dis. 2008;40:690-6.

Tan L, Zhou HJ, Hartman M, Ganpathi IS, Madhavan K, Chang S. Laparoscopic drainage of cryptogenic liver abscess. Surg Endosc. 2013;27:3308-14.

Aydin C, Piskin T, Sumer F, Barut B, Kayaalp C. Laparoscopic drainage of pyogenic liver abscess. JSLS. 2010;14:418-20.

Cappuccino H, Campanile F, Knecht J. Laparoscopy-guided drainage of hepatic abscess. Surg Laparosc Endosc. 1994;4:234-7.

Lorenz J, Thomas JL. Complications of percutaneous fluid drainage. Semin Intervent Radiol. 2006;23:194-204.

Chandrashekhara SH, Gamanagatti S, Arora R, Goyal P, Saraya A. Percutaneous management of inadvertently inserted catheter into inferior vena cava during liver abscess drainage. Cardiovasc Intervent Radiol. 2010;33:1066-8.

Tay KH, Ravintharan T, Hoe MN, See AC, Chng HC. Laparoscopic drainage of liver abscesses. Br J Surg. 1998;85:330.