Video-assisted hepatic abscess debridement

Abstract

Background: Pyogenic liver abscesses are currently treated by either percutaneous computer tomography (CT)-guided drainage or by laparoscopic and a conventional liver resection when conservative treatment fails but may be associated with substantial morbidity and mortality.

Methods: A minimally invasive technique involving debridement of right liver abscesses was employed using a minimally invasive video-assisted hepatic abscess debridement (VAHD) after unsuccessful percutaneous CT-guided drainage. Clinical data, complication rates and outcomes of patients were recorded retrospectively.

Results: Between 2011 and 2014, VAHD was performed on 10 patients at two centres with no observed recurrence of a liver abscess. The median age of the patients was 57 years (range 42-78) with a median pre-operative size of a liver abscess of 78 mm (range 40-115). The median operation time was 47 min (range 23-75), and the median postoperative hospital stay was 9 days (range 7-69). One patient developed a subcutaneous abscess that required further surgery. No patient died, and there were no major complications related to the VAHD.

Conclusions: Video-assisted hepatic abscess debridement is a feasible technique that shows promising results for the treatment of a recurrent right liver abscess.

Figure 1

(a and b) demonstrate a typical right hepatic abscess and a follow-up computed tomography (CT) at 3 months after video-assisted hepatic abscess debridement (VAHD) (c, d)

Figure 2

Pre-operative situation with the guidance drainage in the right upper flank (a); pre-operative situation with the guidance drainage in the right upper flank after disinfection (b); spindle-shaped excision around the guidance drainage (c). Excised liver abscess after debridement with a lavage-suction 16 F-drain sutured to the skin (d)