Evolving management of pyogenic liver abscess: A narrative review of laparoscopic and open drainage approaches with contextual insights from Pakistan.

Objectives: Pyogenic liver abscess remains a high-risk condition, where clinical management has improved with modern advancements. In our study, we have attempted to compare the outcomes of laparoscopic and open surgical drainage as surgical management options, with contextual insights from Pakistan, where local studies remain scarce. Methodology: Articles were obtained from PubMed, Cochrane, ScienceDirect and Google Scholar from 2000 to 2025 using keywords such as "pyogenic liver abscess," "laparoscopic drainage," and "hepatic abscess management." Outcomes, including mortality, morbidity, recurrence, hospital stay, and recovery time, were analyzed. Four comparative studies formed the core evidence and were supported by other reports. Results: We found that both laparoscopic and open drainage are effective in reducing mortality and recurrence rates. However, laparoscopic drainage was associated with lower morbidity, shorter hospital stays, and faster recovery duration. Recurrence had a variable result across studies, with favorable outcomes for the laparoscopic approach. Limitations faced include the limited availability of comparative studies, which were mostly single-centre, thereby not providing an overall picture of the situation in Pakistan. Conclusion: Our takeaway is that laparoscopic drainage is safer, more effective, and preferable where feasible in comparison to open-surgical treatment for surgical management. We also highlighted that access to laparoscopic drainage in lower- and middle-income areas should be enhanced through resource integration and capacity building for better healthcare. There is also a need to conduct further research, including more comparative studies, randomized controlled trials, and long-term cohorts, to gain a comprehensive comparative understanding of the various surgical approaches and potential future approaches.