title: Role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy.
abstract: OBJECTIVE
  To evaluate the role and outcome of conventional surgery in the treatment of pyogenic liver abscess in the modern era of minimally invasive therapy.
  
  
  METHODS
  The medical records of thirteen patients with pyogenic liver abscess who underwent surgical treatment between January 1995 and December 2002 were retrospectively reviewed to determine the clinical presentation, indication and nature of surgery, and outcome of surgery.
  
  
  RESULTS
  The patients were predominantly women (10/13) with a mean age of 65 +/- 17 years. Their main presenting symptoms were abdominal pain (100%) and fever (77%). The aetiologies included biliary (n = 6), cryptogenic (n = 3), portal (n = 2), and trauma (n = 2). Seven patients underwent percutaneous drainage as the initial treatment. Of these, three patients developed peritonitis secondary to peritoneal spillage. Another four patients failed to respond because of multiloculation. Salvage surgery was required in these patients. Six patients proceeded to straight laparotomy: two had marked sepsis and multiloculated abscess that precluded percutaneous drainage, and four presented with peritonitis of uncertain pathology. Surgical procedures included deroofment and drainage (n = 9), liver resection (n = 3), peritoneal lavage (n = 2), cholecystectomy (n = 4), and exploration of common bile duct (n = 2). One patient required reoperation because of bleeding. Three patients required further percutaneous drainage after surgery. The overall mortality was 46%. Four patients died of multiorgan failure and two patients died of pulmonary embolism.
  
  
  CONCLUSIONS
  Surgical treatment of pyogenic liver abscess is occasionally needed when percutaneous drainage has failed due to various reasons. Mortality rate in this group of patients has remained high.
authors.affiliation: Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China. simonng@surgery.cuhk.edu.hk
authors.forename: Simon Siu-Man
authors.initials: SS
authors.lastname: Ng
authors.forename: Janet Fung-Yee
authors.initials: JF
authors.lastname: Lee
authors.forename: Paul Bo-San
authors.initials: PB
authors.lastname: Lai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D046290:Liver Abscess, Pyogenic / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011859:Radiography; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods*; D016896:Treatment Outcome