Ndong A, Tendeng JN, Diallo AC, Dieye A, Diao ML, Diallo S, Diop S, Diallo MK, Diedhiou M, Fall ML, Ma Nyemb PM, Konaté I. Efficacy of laparoscopic surgery in the treatment of hepatic abscess: A systematic review and meta-analysis.
Ann Med Surg (Lond) 2022;
75:103308. [PMID:
35198179 PMCID:
PMC8850317 DOI:
10.1016/j.amsu.2022.103308]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/19/2022] [Accepted: 01/23/2022] [Indexed: 11/24/2022] Open
Abstract
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.
Surgery in the treatment for liver abscess has its indications limited to ruptured liver abscess, particularly in the peritoneal cavity.
Laparoscopy can be used both for unruptured and ruptured liver abscess when there are failure or contraindications of percutaneous drainage.
This review suggest the safety and feasibility of laparoscopy with a low rate of post-operative recurrent or residual liver abscess.
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