A pyogenic liver abscess is a collection of pus in the liver due to bacterial infection. An abscess may lead to localized pain and swelling. Most often a pyogenic liver abscess is due to an infection in the biliary tree. Other causes of a pyogenic liver abscess include appendicitis, pancreatic cancer, colonic cancer, diverticulitis, inflammatory bowel disease, septicemia and trauma to the liver.
Symptoms of a pyogenic liver abscess include, fever with chills, vomiting, pain in the right upper abdomen, sudden weight loss, dark colored urine, diarrhea etc.
Some patients may benefit from antibiotic therapy alone. However, most patients need drainage of the liver abscess. Nowadays, this is usually performed by percutaneous aspiration under ultrasound or CT guidance. Rarely a laparoscopic liver abscess drainage may be needed.
Laparoscopic drainage of liver abscess surgery is a surgical procedure performed for patients who have failed to respond to percutaneous treatment or patients with extra-large abscesses in the liver. Laparoscopic drainage of liver abscess surgery must be considered as a treatment option when all other treatment modalities have failed.
Laparoscopic drainage of liver abscess surgery is also recommended if there are peritoneal symptoms in a patient with pyogenic liver abscess and surgery may have to be performed to prevent the abscess from rupturing in to the peritoneal cavity.
Laparoscopic drainage of liver abscess surgery together with antibiotic therapy is a very critical step when it comes to managing liver abscesses. Emergency drainage is recommended if a patient is haemodynamically unstable with shock or has multi-organ dysfunction.
General anesthesia is usually used during laparoscopic liver abscess drainage surgery. During the surgery, the surgeon makes a small incision below the umbilicus. Next, the surgeon establishes pneumoperitoneum and then places a laparoscope into the peritoneal cavity. The position of the liver abscess to be drained and its size play a significant role when it comes to determining the port site positions.
While under the guidance of a laparoscope, the surgeon uses an electrocautery device to separate liver adhesions from the abdominal wall and diaphragm. In cases of superficial and extra-large liver abscesses, the liver surface is usually elevated with a gray-white or yellow-white color. The pus from the liver abscess is removed through a paracentesis, and then a small hole is made on the thinnest or elevated surface of the liver swelling. The surgeon then unroofs the abscess cavity with an electrocautery instrument. It is critical for the surgeon to obtain samples for drug sensitivity and bacterial culture testing.
Next, the doctor performs debridement and irrigation of the liver abscess. After that, the surgeon installs thick latex drainage tubes in the abscess cavity and subhepatic space correspondingly. The drainage tubes should be left in place until a B-ultrasonic image or CT confirms the collapse of the abscess cavity. This mostly happens between 6 to 9 days after the laparoscopic surgery and when the drainage liquid falls to below 20 ml every 24 hours.
Laparoscopic drainage of liver abscess surgery can be done safely. Also, time required to perform the surgery is significantly reduced.
Laparoscopic drainage of liver abscess surgery does away with access trauma and can assist the doctor to identify predisposing pathology. Intraoperative laparoscopic ultrasonography can help the doctor to identify the location of the liver abscess accurately. The laparoscopic approach to draining liver abscess also comes with the following benefits:
Usually patients are given water and other liquids 6 hours after surgery. Once the patient tolerates liquids, they can be given a light meal, and also the IV line can be removed. Patients must go easy on their diet for the first 3 to 4 days and minimize oil and spice for 2 weeks post surgery.
At times, a patient can feel nauseated after the anesthesia wears off. This feeling should pass after a few hours, but if it doesn’t, the patient can be given medication to relieve it.
The patient can be given a prescription for pain medication to manage pain which might occur after the surgery. The incision sites are covered with small adhesive bandages, which can be removed after five days. The stitches may not be removed as they usually dissolve over time.
A patient can resume normal, light daily activities after 24 hours and can return to work after 7 to 10 days. The patient should avoid strenuous activities and heavy lifting until 3 months post surgery.
If the bacteria are released and spread throughout the patient’s body, it can lead to the following:
Laparoscopic drainage of pyogenic liver abscess surgery cost greatly varies with the hospital, type of room selected etc. The average cost of laparoscopic drainage of pyogenic liver abscess surgery also depends upon the duration of surgery and number of days in the hospital. The cost of this surgery is usually covered by insurance.