Journal Article

Laparoscopic drainage of cryptogenic liver abscess

Hartman, Mikael, Tan, Liza, Zhou, Hui Jun, Ganpathi, Iyer Shridhar, Madhavan, Krishnakumar, Chang, Stephen

2013

Overview

Background To retrospectively compare the outcomes of percutaneously drained and laparoscopically drained liver abscesses. Methods Eight-five consecutive patients with radiological evidence of liver abscess were treated at National University Hospital of Singapore from 2005 to 2011. Multivariable logistic regression was used to identify failures of intervention. This was defined as persistent objective signs of sepsis. Complications, length of antibiotic therapy, and hospital stay were recorded but not used as indicators for failure of intervention. A propensity score analysis was used to adjust for possible confounders. Results Twenty-seven (40.3 %) patients in the percutaneous group did not respond to primary intervention compared to 2 patients (11.1 %) in the laparoscopic group ( p  = 0.020). Two patients within the percutaneous group died from progression of sepsis despite intervention. In the multivariate model with propensity score, laparoscopic drainage had a protective effect against failure compared to percutaneous drainage of liver abscess (odds ratio [OR], 0.03; 95 % confidence interval [CI], [0–0.4]; p  = 0.008). There were no differences in complications related to the intervention ( p  = 0.108). Mean duration of antibiotics ( p  = 0.437) and hospital stay ( p  = 0.175) between the groups was similar. Conclusions Laparoscopic drainage of cryptogenic liver abscesses should be considered as an option for drainage of liver abscess.

• Publisher: Springer US,Springer Nature B.V
• Subject: Abdominal Surgery / Abscesses / Anti-Bacterial Agents - therapeutic use / Antibiotics / Catheters / Drainage - methods / Failure / Female / Gastroenterology / General anesthesia / Gynecology / Hepatology / Humans / Laparoscopy / Laparoscopy - methods / Liver / Liver Abscess, Pyogenic - drug therapy / Liver Abscess, Pyogenic - mortality / Liver Abscess, Pyogenic - surgery / Male / Medicine / Medicine & Public Health / Middle Aged / Patients / Proctology / Propensity Score / Retrospective Studies / Sepsis / Surgery / Treatment Outcome / Ultrasonic imaging