Page 13 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Laparoscopic vs Open Drainage of Complex Pyogenic

Liver Abscess

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Mohamed M Mogahed , Ashraf A Zytoon , Basem Eysa , Mohamed Manaa , Wessam Abdellatif 5
AbstrAct
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.
Keywords: Laparoscopy, Open drainage, Pyogenic liver abscess.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1395

IntroductIon 1
Department of Surgery, National Hepatology and Tropical Medicine
Complex pyogenic liver abscess (CPLA) is a rare potentially fatal Research Institute, Cairo, Egypt
condition if untreated. Complex pyogenic liver abscess is an abscess 2 Department of Radiodiagnosis, Faculty of Medicine, Menoufia
that is multilocular and more than 5 cm in diameter. Pyogenic University, Menoufia, Egypt
liver abscess (PLA) is mainly treated by percutaneous aspiration or 3,4 Department of Tropical Medicine, National Hepatology and Tropical
drainage under antibiotic cover. Surgical drainage is indicated if Medicine Research Institute, Cairo, Egypt
interventional radiology fails, if ruptured, or if associated with biliary 5 Department of Radiology, National Hepatology and Tropical Medicine
or intra-abdominal pathology. In CPLA, percutaneous drainage may Research Institute, Cairo, Egypt
1,2
help to optimize clinical condition before surgery. Laparoscopic Corresponding Author: Ashraf A Zytoon, Department of Radio-
drainage is a promising surgical option. 3 diagnosis, Faculty of Medicine, Menoufia University, Menoufia, Egypt,
Large pyogenic multilocular abscesses usually need drainage, in Phone: +201000219818, e-mail: ashradio@gmail.com
1
addition to antibiotics for effective management. Antibiotics alone How to cite this article: Mogahed MM, Zytoon AA, Eysa B, et al.
does not work because of large bacterial load, antibiotics inactivation, Laparoscopic vs Open Drainage of Complex Pyogenic Liver Abscess.
and ineffective medium for bacterial elimination. Effective drainage World J Lap Surg 2020;13(1):11–15.
shortens the antibiotic therapy duration. The methods include Source of support: Nil

percutaneous needle aspiration (PNA), percutaneous catheter drainage Conflict of interest: None
(PCD), open surgical drainage (OSD), and laparoscopic drainage (LD). 4
Patients with small, solitary, and unilocular abscesses are best
managed with percutaneous aspiration plus antibiotics, especially

the young healthy patients. Debilitated patients, elderly, diabetic MAterIAls And Methods
patients, and patients with multiple or CPLA have a higher failure
rate with percutaneous aspiration. 5 Combined retrospective and prospective comparative study was
conducted in NHTMRI from January 2012 to January 2020 on 48
Aim patients (20 males and 28 females) with a median age of 54.5
To evaluate the safety and efficacy of laparoscopic drainage as a years (ranges between 34 years and 65 years) having complex
management of complex pyogenic liver abscesses in comparison liver abscesses managed by either laparoscopic drainage or
to open surgical drainage. open surgical drainage. The comparison is as regards results,
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