Efficacy of laparoscopic surgery in the treatment of hepatic abscess: A systematic review and meta-analysis.

BACKGROUND

Liver abscess is a common cause of intra-abdominal infection and its treatment depends on the presentation. Laparoscopy, in addition to its classic benefits, has particular advantages in the management of liver abscess but its role is not well defined and studies done in that field are heterogenous. The objective of this systematic review is to evaluate the efficacy of laparoscopic surgery in the management of liver abscess.

METHODS

We realized a systematic review and meta-analysis including studies published in the 20 last years. The primary outcome was the pooled prevalence of recurrent or residual liver abscess after laparoscopic treatment.

RESULTS

We retrieved 190 studies regarding laparoscopic surgery in liver abscess and 17 studies were included in the quantitative and qualitative synthesis. A total of 608 patients was included and 299 of them (49.1%) were treated by laparoscopic surgery. The indications were mainly failure of first line treatment (antibiotic treatment and/or percutaneous drainage and/or needle aspiration) and ruptured multiloculated, or caudate lobe liver abscess. The surgical gesture performed was laparoscopic drainage in all studies. The post-operative rate of recurrent or residual liver abscess after treatment by laparoscopy was 4.22% (95% CI: 2.29-7.07).

CONCLUSIONS

This systematic review showed that laparoscopic drainage had a considerable place in the management. The post-operative rate of recurrence was low with no mortality suggesting that laparoscopy is safe and feasible for liver abscess management.