European Journal of Cardiovascular Medicine

Pyogenic liver abscess (PLA) is a potentially life-threatening condition characterized by a localized collection of pus in the liver, commonly caused by bacterial infections reaching the liver via the biliary tract, portal vein, or systemic circulation (1). The incidence of PLA varies globally, with higher prevalence reported in developing countries due to poor sanitation and limited access to healthcare (2). Common etiological organisms include Escherichia coli, Klebsiella pneumoniae, and Streptococcus species, with K. pneumoniae being particularly dominant in Asia (3,4).

The management of PLA has evolved significantly over the years. While antibiotics remain the cornerstone of treatment, abscesses larger than 5 cm or those unresponsive to medical therapy often necessitate drainage (5). Traditionally, open surgical drainage (OD) was considered the standard of care for complicated or multiloculated abscesses. However, with advancements in minimally invasive techniques, laparoscopic drainage (LD) has emerged as a feasible and less invasive alternative (6).

Laparoscopic surgery offers several advantages, including reduced postoperative pain, shorter hospital stay, lower morbidity, and quicker recovery (7,8). Nevertheless, concerns regarding its applicability in large or complex abscesses and the need for surgical expertise have limited its widespread adoption in certain settings (9). Comparisons between LD and OD in terms of clinical outcomes, complication rates, and convalescence remain relatively under-explored, especially in the context of resource-limited healthcare systems (10).

This study aims to evaluate and compare the effectiveness, safety, and recovery outcomes of laparoscopic versus open surgical drainage in patients diagnosed with pyogenic liver abscess.

A total of 60 patients diagnosed with pyogenic liver abscess were included based on clinical presentation, radiological findings (ultrasonography and/or contrast-enhanced CT scan), and laboratory confirmation of infection. Inclusion criteria were: age between 18 and 70 years, abscess size ≥5 cm, unilocular or multilocular configuration, and no response to intravenous antibiotics within 48–72 hours. Patients with amoebic liver abscess, multiple organ dysfunction, uncorrectable coagulopathy, or contraindications to laparoscopy were excluded.

Grouping and Intervention:
Participants were randomly allocated into two groups using a computer-generated random number table. Group A (n=30) underwent laparoscopic drainage (LD), while Group B (n=30) received open surgical drainage (OD).

• Laparoscopic Procedure: After general anesthesia, three standard trocar ports were placed. The abscess was localized and accessed under direct vision, followed by evacuation of pus, thorough lavage, and placement of a drain.
• Open Surgical Procedure: Under general anesthesia, a subcostal incision was made to access the abscess. Pus was drained, and the cavity was irrigated and packed with a drain.

Postoperative Management and Follow-up:
All patients received empirical broad-spectrum intravenous antibiotics, adjusted based on culture sensitivity results. Clinical parameters, including fever resolution time, pain score, time to oral intake, duration of hospital stay, and wound healing, were documented. Complications such as surgical site infection, re-intervention, and residual abscess formation were noted.

Outcome Measures:
The primary outcomes assessed were operative duration, postoperative complications, and length of hospital stay. Secondary outcomes included time to return to normal activities and need for re-intervention.

Statistical Analysis:
Data were entered into Microsoft Excel and analyzed using SPSS version 25. Quantitative variables were expressed as mean ± standard deviation and compared using the independent Student’s t-test. Categorical variables were analyzed using the chi-square test. A p-value less than 0.05 was considered statistically significant

A total of 60 patients were included in the study, with 30 patients each in Group A (Laparoscopic Drainage) and Group B (Open Drainage). Both groups were comparable in terms of age, gender, and abscess characteristics at baseline.

Table 1 shows the demographic and clinical profile of patients in both groups. The mean age was 45.6 ± 11.4 years in Group A and 47.1 ± 12.2 years in Group B. Males predominated in both groups (76.7% in Group A and 73.3% in Group B). The average abscess size was 6.8 ± 1.5 cm in Group A and 6.7 ± 1.6 cm in Group B, with no statistically significant difference (p > 0.05) (Table 1).

Table 1: Baseline Characteristics of Patients

Intraoperative and Postoperative Outcomes:
Group A had a shorter operative time (72.4 ± 10.2 minutes) compared to Group B (94.6 ± 12.8 minutes), which was statistically significant (p < 0.01). The postoperative complication rate was lower in Group A (10%) than in Group B (26.7%) (p = 0.041). The mean hospital stay was also significantly reduced in Group A (5.2 ± 1.1 days) compared to Group B (8.5 ± 1.4 days) (p < 0.001). Details are summarized in Table 2.

Table 2: Intraoperative and Postoperative Outcomes

Recovery Time:
Patients in the laparoscopic group returned to daily activities significantly earlier (mean: 12.1 ± 3.4 days) compared to the open drainage group (mean: 20.3 ± 4.2 days) (p < 0.001), as shown in Table 3.

Table 3: Recovery Time

The findings indicate a clear advantage of laparoscopic drainage over open surgical drainage in terms of operative efficiency, fewer complications, and faster recovery (Tables 1–3).

Pyogenic liver abscess (PLA) remains a significant clinical challenge, particularly in regions with high prevalence of gastrointestinal infections and biliary tract diseases. The findings of this study demonstrate that laparoscopic drainage (LD) offers notable advantages over open surgical drainage (OD) in the management of PLA, especially in terms of reduced operative time, fewer postoperative complications, shorter hospital stay, and quicker return to daily activities.

The average operative duration in the LD group was significantly shorter than in the OD group. This aligns with prior studies suggesting that minimally invasive techniques reduce surgical stress and exposure time (1,2). Furthermore, the smaller incision size in laparoscopy contributes to faster recovery and improved patient comfort (3).

Our results showed a significantly lower complication rate in patients undergoing LD. Postoperative infections, wound dehiscence, and intra-abdominal abscess recurrence were more frequently observed in the open surgery group. Similar findings have been reported in other studies emphasizing the benefit of laparoscopy in reducing wound-related complications (4,5). The magnified visualization in laparoscopy allows for more precise drainage and lavage, which may explain the reduced infection rates observed in our study (6).

Hospital stay is a critical determinant of healthcare costs and resource utilization. In our study, patients managed laparoscopically had shorter hospital stays than those who underwent open procedures, which is consistent with previous reports (7,8). Faster mobilization and lower postoperative pain in the LD group likely contributed to this difference (9).

Return to normal activities was significantly quicker in the laparoscopic group. This reflects the minimal invasiveness and lower systemic impact of laparoscopy, which has been observed in other abdominal surgeries, including cholecystectomy and appendectomy (10,11). Early resumption of routine activities not only benefits patients' quality of life but also has socioeconomic implications (12).

The reduced morbidity observed in the LD group is particularly important in immunocompromised or elderly patients, where rapid recovery is essential. Moreover, the cosmetic benefits of laparoscopy are non-negligible, especially for younger patients (13). However, laparoscopy requires skilled surgeons and access to appropriate infrastructure, which may limit its application in resource-limited settings (14). In such scenarios, OD may still have a role, especially in complex, multiloculated abscesses or when laparoscopy is contraindicated (15).

Overall, this study supports the growing body of evidence that laparoscopic drainage should be considered a first-line surgical option in the management of PLA in eligible patients.

Laparoscopic drainage is a safe and effective alternative to open surgical drainage for managing pyogenic liver abscess, offering benefits such as shorter operative time, reduced complications, faster recovery, and shorter hospital stay. It should be considered the preferred approach in suitable patients, provided adequate surgical expertise and resources are available.

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