Laparoscopic drainage of large liver abscess, postoperative course, safety and efficacy

Abstract

Background: In the era of minimal invasive surgical techniques, laparoscopic drainage provides faster recovery, shorter hospital stay, less surgical site infection and better cosmesis than open surgical drainage does with added advantage of accurate positioning of drainage catheter and simultaneous treatment of the abscess and underlying abdominal pathology. Methods: A total of 33 patients of age group 18-65 years were enrolled. Diagnosis was made using ultrasonography and CECT abdomen and laparoscopic drainage done and drain placed. Adequacy of drainage of abscess was analyzed using ultrasonography on POD- 5, 20 and 30 and were followed upto 3 months. Day of intra-cavitary drain removal, duration of post operative hospital stay, complications after surgery, requirement of readmission and intervention after readmission were recorded and analyzed. Results: Out of 33 patients, 1 patient developed sinus tract formation at intracavitary drain site. 3 patients had inadequate drainage for which drain change was required. 33% (N=11) patients showed complete resolution of abscess at post operative day 20 where as 72.7% patients (N=24) showed complete resolution of abscess on post operative day 30. All 33 patients showed complete resolution of abscess after 3 months of surgery. Conclusions: Laparoscopic procedure provides every advantages of open surgical drainage of liver abscess while avoiding complications of open surgeries. It allows breakdown of loculations, drainage of viscid pus, necrotic tissues, adequate irrigation of abscess cavity and should be considered for patients with large, complex, septated or multiple abscesses and failed percutaneous drainage.