Role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy

Abstract

INTRODUCTIONWhen not diagnosed early and treated promptly, pyogenic liver abscess can be fatal, with reported mortality rates as high as 80%-100% [1] . Historically, the treatment of choice for pyogenic liver abscess had been open surgical drainage [2] . However, with the advent of minimally invasive therapy such as image-guided percutaneous needle aspiration or catheter drainage and the availability of broadspectrum antibiotics, patients with pyogenic liver abscess nowadays seldom require open surgery for treatment [3,4] . We aim to evaluate the role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy. MATERIALS AND METHODSBetween January 1995 and December 2002, one hundred patients with pyogenic liver abscess were treated at our institution. Among them, thirteen patients required open surgical treatment. The medical records of these thirteen patients were retrospectively reviewed to determine the demographic data, clinical presentation, indications and nature of surgery, and outcome of surgery.The diagnosis of pyogenic liver abscess was established by a combination of clinical, radiological, operative, and/ or microbiological findings. All patients with suspected Abstract AIM: To evaluate the role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy.

Outcome of ultrasound guided pigtail catheter drainage of liver abscesses a prospective study of 126 cases

“…Amoebic serology was performed, because of endemicity of amoebiasis in our region and because of financial constraints, as most of our patens belonged to poor economic status, comparable with the available studies. [31][32][33] In the beginning of the study 8-10F pigtail catheters were used to drain the abscess percutaneously, but in 03 out of 05 patients the catheter drainage failed owing to small bore catheter and very thick pus leading to laparotomy. Later we switched on to using 12-14F pigtail catheter with good results.…”

Pyogenic Liver Abscess after Bile Duct Exploration Drained with Endoscopic Techniques

“…PLAs in control is a stateof-the-art. Majority of PLAs could be drained by minimally invasive therapy including ultrasound-guided PTD [2], the others have to face surgical therapy [3,4]. However, PLAs after surgery is seldom reported, which will push surgeons into a "dilemma" situation when noninvasive therapy always failures to drain immature PLAs.…”

Intra-abdominal abscesses – current diagnosis and therapy

“…Badanie RTG klatki piersiowej jest przydatne w diagnostyce ropni podprzeponowych oraz narządowych, głównie wątroby i śledziony [2,21,[27][28][29]. U części chorych można dzięki niemu stwierdzić wysięk w opłucnej, niedodmę lub zapalenie dolnych odcinków płuc.…”

“…Rzadziej wykonywane badania radiologiczne to fistulografia oraz endoskopia z wykorzystaniem środka kontrastowego lub kontrastowe badanie przewodu pokarmowego [9,10,28,29]. Badania te mogą być przeprowadzone tylko w wybranych przypadkach.…”

“…Istnieją również pewne wskazania u pacjentów po operacjach resekcyjnych przewodu pokarmowego, szczególnie wtedy, gdy stan chorego jest stabilny, a zachodzi podejrzenie przetoki w zespoleniu. Badania te mają na celu ustalenie przyczyny ropnia oraz określenie sposobu postępowania terapeutycznego [10,24,28,30].…”