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

Table 1 Clinical features, imaging results, preoperative diagnoses, and aetiologies of pyogenic liver abscess

No.	Sex/age	Coexisting diseases	Clinical features	US/CT findings	Preoperative diagnosis	Aetiology
1	F/74	History of jaundice	Peritonitis, hepatomegaly	18 cm left lobe cyst	Ruptured liver cyst	Biliary (GS)
2	F/83	HT, history of cholecystectomy	Pain, fever	2 cm left lobe abscess	Liver abscess	Biliary (CBDS)
3	M/66	DM	Pain, hepatomegaly	12 cm right lobe abscess	Liver abscess	Cryptogenic
4	F/83	HT, history of cholecystectomy and partial gastrectomy	Peritonitis, abdominal distension	(Dilated small bowel loops on abdominal X-ray)	Ischaemic bowel	Biliary (CBDS)
5	M/39	Recent blunt liver trauma with partial hepatectomy	Pain, fever	Haematoma and abscess along liver resection margin	Liver abscess	Trauma
6	M/34	Gunshot injury to liver with partial hepatectomy 4 months ago	Pain, fever, abscess pointing out	5.5 cm abscess communicating with anterior abdominal wound	Liver abscess	Trauma
7	F/86	HT, DM	Peritonitis, fever, hepatomegaly	Multiple liver cysts, largest one 18 cm in the right lobe	Ruptured liver cyst	Biliary (cystadenoma)
8	F/60	RPC, history of cholecystectomy and HJ	Pain, septic shock	5 cm left lobe abscess	Liver abscess	Biliary (RPC)
9	F/71	Diverticular disease	Pain, fever	13 cm right lobe abscess	Liver abscess	Portal (diverticulitis)
10	F/77	HT, history of thyroidectomy for cancer	Pain, fever	9 cm right lobe abscess	Liver abscess	Cryptogenic
11	F/60	No	Peritonitis, septic shock	Suspected acute cholecystitis	Acute cholecystitis	Biliary (GS)
12	F/64	No	Pain, septic shock	4.5 cm left lobe abscess	Liver abscess	Cryptogenic
13	F/47	DM	Pain, fever	9 cm left lobe and 3.5 cm right lobe abscesses	Liver abscess	Portal (diverticulitis)

HT: Hypertension; DM: Diabetes mellitus; RPC: Recurrent pyogenic cholangitis; HJ: Hepaticojejunostomy; GS: Gallstones; CBDS: Common bile duct stones.

Table 2 Indications, nature, and outcome of surgery

	Initial intervention	Indications of surgery	No.	Details	Nature of surgery	Outcome
Pyogenic liver abscess (n = 13)	Ultrasonography-guided drainage attempted (n = 7)	Complications arising from percutaneous drainage (n = 3)	2	Peritoneal spillage	D&D	Survive
			3	Peritoneal spillage	Lavage	Survive
			9	Peritoneal spillage	Lavage	Survive
		Failed percutaneous drainage (n = 4)	5	Multiloculated abscess	D&D, debridement	Die of MOFS
			10	Multiloculated abscess	D&D, chole, ECBD	Die of PE
			12	Multiloculated abscess	L lat sec, chole	Die of MOFS
			13	Multiloculated abscess	L lat sec, D&D	Survive
	Straight laparotomy (n = 6)	Peritonitis of uncertain diagnosis (n = 4)	1	Ruptured liver cyst?	D&D, chole	Die of MOFS
			4	Ischaemic bowel?	D&D, ECBD	Die of MOFS
			7	Ruptured liver cyst?	D&D	Survive
			11	Acute cholecystitis?	D&D, chole	Die of PE
		Percutaneous drainage not suitable (n = 2)	6	Multiloculated abscess pointing out	D&D, debridement	Survive
			8	Multiloculated abscess in a septic patient	L lat sec	Survive

D&D: Deroofment and drainage; chole : cholecystectomy; ECBD: Exploration of common bile duct; L lat sec: Left lateral sectionectomy; MOFS: Multiorgan failure syndrome; PE: Pulmonary embolism.