Laparoscopy-guided drainage of hepatic abscess

Hepatic abscess is a serious surgical condition with a mortality rate of up to 63% reported if not adequately treated. Laparotomy and computed tomographic (CT) guidance have been used to drain these collections, each with their own problems. Herein we describe a method of draining laparoscopically a hepatic abscess. A 45-year-old Haitian man presented with night sweats and fevers to 103 degrees F; he was diagnosed by CT to have a large (7 cm) abscess in the posterosuperior portion of the right hepatic lobe. The CT-guided drainage yielded only 8 cc fluid. The patient underwent laparoscopy-guided drainage of the abscess with placement of intra-hepatic and perihepatic drains. The patient had dramatic clinical improvement with no morbidity from the procedure. A follow-up CT of the abdomen revealed near-complete disappearance of the abscess cavity within 48 h. A straightforward method of laparoscopic drainage of hepatic abscesses is presented in detail. It provides a simple alternative for drainage with excellent results and minimal morbidity.