Page 17 - World Journal of Laparoscopic Surgery

Drainage of Complex Pyogenic Liver Abscess
Preoperative ultrasound, CT, MRI, and intraoperative references
laparoscopic ultrasound help to identify abscess localization,
liquefaction, cavity size, pus volume, multiloculation, septa, and 1. Chung YF, Tan YM, Lui HF, et al. Management of pyogenic liver
abscesses—percutaneous or open drainage? Singapore Med J
abscess number. Abdominal ultrasonography was done in all 2007;48(12):1158–1165.
patients and was diagnostic alone in 24 (50%) of cases; however, 2. Wankg W, Lee WJ, Wei PL, et al. Laparoscopic drainage of pyogenic
CT was required in 22 patients and MRI in 2 patients to confirm liver abscesses. Surg Today 2004;34(4):323–325. DOI: 10.1007/s00595-
the diagnosis. This is comparable to Serraino et al. study in which 003-2709-x.
ultrasound was diagnostic in 42.4%, CT scan in 51.1%, and MRI in 3. Cioffi L, Belli A, Limongelli P, et al. Laparoscopic drainage
3.3% of their cases. 14 as first line treatment for complex pyogenic liver abscesses.
Seventy-nine percentage of our patients in this study had Hepatogastroenterology 2014;61(131):771–775.
positive culture reports while 21% had reports with no growth. 4. Bowers ED, Robison DJ, Doberneck RC. Pyogenic liver abscess. World
J Surg 1990;14(1):128–132. DOI: 10.1007/BF01670563.
The most common organisms identified were Escherichia coli 5. Aydin C, Piskin T, Sumer F, et al. Laparoscopic drainage of pyogenic
25% and Klebsiella pneumoniae 16%. This is comparable to results liver abscess. JSLS 2010;14(3):418–420. DOI: 10.4293/108680810X129
of Malik et al., Serraino et al., and different from Liu et al. who 24466006567.
found that 25 positive results of 66 cases (37.9%), with Klebsiella 6. Bächler P, Baladron MJ, Menias C, et al. Multimodality imaging of liver
pneumoniae detected in 15 cases (60.0%) as the most common infections: differential diagnosis and potential pitfalls. Radiographics
pathogen. 14–16 2016;36(4):1001–1023. DOI: 10.1148/rg.2016150196.
The operative time and hospital stay were less and oral 7. Lin AC, Yeh DY, Hsu YH, et al. Diagnosis of pyogenic liver abscess by
feeding was started earlier in laparoscopic drainage group. This abdominal ultrasonography in the emergency department. Emerg
Med J 2009;26(4):273–275. DOI: 10.1136/emj.2007.049254.
is comparable to Tu et al. study as regards hospital stay and 8. Benedetti NJ, Desser TS, Jeffrey RB. Imaging of hepatic
oral feeding but not for operation time as Tu and his colleagues infections. Ultrasound Q 2008;24(4):267–278. DOI: 10.1097/
had longer LS time perhaps because they managed the biliary RUQ.0b013e31818e5981.
pathology at the same time. 17 9. Mortelé KJ, Segatto E, Ros PR. The infected liver: radiologic-pathologic
In the current study, there were no perioperative mortality correlation. Radiographics 2004;24(4):937–955. DOI: 10.1148/
which is comparable to Tu et al. study and in contrary to the rg.244035719.
study done by Malik et al., in which mortality occurred in 19 of 10. Alsaif HS, Venkatesh SK, Chan DS, et al. CT appearance of pyogenic
169 patients with pyogenic liver abscesses and it was higher in liver abscesses caused by Klebsiella pneumoniae. Radiology
2011;260(1):129–138. DOI: 10.1148/radiol.11101876.
the nonsurgical drainage group (7 out of 42 patients 16.6%) than 11. Doyle DJ, Hanbidge AE, O’Malley ME. Imaging of hepatic infections.
the surgically drained group (12 out of 127 patients 9.4%). 15,17 As Clin Radiol 2006;61(9):737–748. DOI: 10.1016/j.crad.2006.03.010.
regards the recurrence rate, it occurred in two cases (4.2%), one 12. Huang CJ, Pitt HA, Lipsett PA, et al. Pyogenic hepatic abscess.
case in laparoscopic group 1/22 (4.5%) and one case in open group Changing trends over 42 years. Ann Surg 1996;223(5):600–607. DOI:
1/26 (3.8%) and both were successfully treated with percutaneous 10.1097/00000658-199605000-00016.
drainage. 13. Liu CH, Gervais DA, Hahn PF, et al. Percutaneous hepatic abscess
drainage: do multiple abscesses or multiloculated abscesses preclude
conclusIon drainage or affect outcome? J Vasc Interv Radiol 2009;20(8):1059–
1065. DOI: 10.1016/j.jvir.2009.04.062.
Both laparoscopic and open surgical drainage of PLA are safe 14. Serraino C, Elia C, Bracco C, et al. Characteristics and management of
and effective. Laparoscopic drainage has less operative time, pyogenic liver abscess: a European experience. Medicine (Baltimore)
morbidity, and hospital stay; however, open drainage is considered 2018;97(19):e0628. DOI: 10.1097/MD.0000000000010628.
the management of choice for patients with critical condition 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.
or with failed percutaneous drainage. When laparoscopic DOI: 10.4240/wjgs.v2.i12.395.
drainage is unsatisfactory conversion to open surgical drainage is 16. Liu L, Chen W, Lu X, et al. Pyogenic liver abscess: a retrospective study
recommended. 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.
dIsclosure 17. Tu JF, Huang XF, Hu RY, et al. Comparison of laparoscopic and open
surgery for pyogenic liver abscess with biliary pathology. World J
Informed written consent was obtained from the patients. Gastroenterol 2011;17(38):4339–4343. DOI: 10.3748/wjg.v17.i38.4339.

World Journal of Laparoscopic Surgery, Volume 13 Issue 1 (January–April 2020) 15