Laparoscopic Approach to Pyogenic Liver Abscess

Overview

Assess the efficacy and safety of laparoscopic management of liver abscess in achieving complete drainage and clinical recovery compared to conventional open or percutaneous methods, and to: 1. To evaluate postoperative complications and recurrence rates. 2. To compare hospital stay, recovery time, and overall morbidity. 3. To determine patient outcomes and cost-effectiveness of laparoscopic intervention.

Liver abscess is a localized collection of pus within the liver parenchyma, most commonly resulting from bacterial or amoebic infection. It remains a serious clinical condition requiring timely diagnosis and effective management to prevent complications such as sepsis or rupture. Traditionally, open surgical drainage was the standard treatment for complicated or multiloculated abscesses and in cases where percutaneous drainage failed. However, advances in minimally invasive surgery have introduced laparoscopic drainage as a safer and more efficient alternative. Laparoscopic management offers several advantages, including smaller incisions, reduced postoperative pain, shorter hospital stays, and faster recovery compared to open surgery. Moreover, it allows direct visualization of the abscess cavity, facilitates breaking of loculations, debridement of necrotic tissue, and precise placement of drainage catheters. These features enhance the completeness of drainage and reduce recurrence rates. Recent studies have demonstrated the efficacy of laparoscopic drainage, particularly in large, complex, or multiloculated liver abscesses where percutaneous methods are unsuccessful or contraindicated. A meta-analysis of 17 studies involving 608 patients reported a recurrence rate of only 4.22% with no procedure-related mortality in the laparoscopic group. Consequently, laparoscopic drainage is now considered a step-up approach in the management algorithm of liver abscess, bridging the gap between percutaneous and open surgical techniques, while ensuring optimal clinical outcomes and reduced morbidity.

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