Key Issues of the Liver Abscesses Surgical Management
A prospective analysis of 165 liver abscesses patient diagnosis and surgical management is presented. Solitaire liver abscesses has been revealed in 105 (63.5%), multiple – in 37 (22.4%) and milliary – in 23 (13,9%) of them. Majority of the patients (n = 92; 55.8%) suffered of the cholangiogenic abscesses. In the rest cases the abscesses were of cryptogenic (n = 30; 18.8%), traumatic (11; 6.7%), postoperative (n = 9; 5.4%), pylephlebitic (n = 9; 5.4%). In Klatskin tumor patients the liver abscesses were noted in 8 (4.2%); contact abscesses – in 6 (3,6%) patients. In the different situations percutaneous punctures (n = 65) as well as drainage (n = 51), and open surgery (n = 36) or antibacterial therapy without any surgery (n = 13) was carried out for the management of liver abscesses. It was adjusted, that in cases of cholangiogenic abscesses percutaneous or convenient surgical external drainage is preferable. Pylephlebitic and cryptogenic liver abscesses can be treated by means of single or several percutaneous punctures. In cases of multiple abscesses spreading on the vast part of the liver sector or lobe (in cases of the Klatskin tumor or benign biliary strictures), anatomical liver resection is indicated. In cases of multiple small cryptogenic abscesses success can be managed applying antibacterial therapy without any surgery on abscesses.