COMPARATIVE STUDY OF PERCUTANEOUS NEEDLE ASPIRATION VERSUS CATHETER DRAINAGE IN TREATING HEPATIC ABSCESS

BACKGROUND Pus Cavity in liver has been known cause of morbidity since the time of Hippocrates (400 BC). It is a common entity in the differential diagnosis of upper abdominal pain. The increasing incidence of Hepatic Abscesses reflects development and uses of more accurate diagnostic techniques like radioisotopes scan and subsequently ultrasonography and CT scan. Treatment of the liver abscess of any aetiology has been made simple and less morbid in the recent years. Percutaneous drainage of liver abscess and thereafter percutaneous pigtail drainage under ultrasonological guidance has been an important advancement in the treatment of liver abscesses as compared to conventional open drainage or conservative medicinal treatment. This study aims to investigate the effectiveness, morbidity and complication rates of Percutaneous Needle Aspiration in comparison to percutaneous continuous pig tail catheter drainage in the treatment of hepatic abscesses. The objectives of this study were- 1. to evaluate the clinical presentation, 2. to assess and compare the effectiveness of percutaneous continuous catheter drainage in comparison to needle aspiration in the treatment of liver abscesses. MATERIALS AND METHODS This prospective comparative study was conducted jointly at Rama Medical College and Regency Hospital, Kanpur from November 2014 to October 2018 on 100 patients of liver abscess, randomized equally into two groups, percutaneous needle aspiration group (PNA) and pigtail catheter drainage group (PCD). For percutaneous needle aspiration, lumbar puncture needle (size 18G to 21G) was used, while the size of pigtail catheter (8f to 12f) was chosen according to thickness of pus assessed by ultrasonography. Both procedures were done under local anaesthesia with 2% Xylocaine. The effectiveness of either treatment was measured in terms of duration of hospital stay, days to achieve clinical improvement, 50% reduction in abscess cavity size and total/near total resolution of abscess cavity. Independent t-test was used to analyse these parameters. Only those patients having liver abscess/abscesses greater than 6 cm in at least one dimension, liquefied & drainable were included in this study. Statistical Analysis- Data was analysed by statistical software package SPSS version 21.0 (SPSS Inc. Chicago, IL, USA). The primary aetiology of abscess as per ultrasonological diagnosis recorded to compare the incidence of different causes of liver abscess in our area. The average (mean) value of duration of hospital stay, time taken for clinical signs of recovery (symptoms like pain, fever, laboratory parameters), mean duration of 50% reduction in size of abscess cavity and duration for near total or total resolution of abscess cavity in two groups as per ultrasonologic measurements of cavity dimensions have been compared. The average postoperative antibiotic treatment duration was noted. All data was analysed to compare the efficacy of two modes of treatment, using independent sample 't' test. The 'p' value < 0.000 is considered significant. RESULTS The study shows amoebic liver abscess is more common than pyogenic abscess in our area with hot humid climate. 50% reduction in volume of abscess cavity in catheter group was earlier as compared to those who underwent percutaneous needle aspiration. The patients in pigtail catheter drainage group showed earlier clinical improvement, and total or near total resolution of abscess cavity was found significantly earlier in per cutaneous catheter drainage technique. The procedure-related complications were found less in catheter group as compared with aspiration group. The overall clinical recovery was significantly earlier in catheter group than in needle aspiration group. Average duration of antibiotic treatment was significantly shorter in catheter group than in needle aspiration group. CONCLUSION Percutaneous pig tail catheter drainage is a better modality as compared to percutaneous needle aspiration especially in larger abscesses which are partially liquefied or abscesses with thick pus.