What is liver abscess incision and drainage? What are the complications, postoperative care, anesthesia, and preoperative preparation for hepatic abscess incision and drainage?

What is liver abscess incision and drainage? What are the complications, postoperative care, anesthesia, and preoperative preparation for hepatic abscess incision and drainage?

What is liver abscess incision and drainage? What are the complications, postoperative care, anesthesia, and preoperative preparation for hepatic abscess incision and drainage?

There are two common methods for incision and drainage of hepatic abscess. One is transabdominal incision and drainage, which can avoid contamination of the abdominal cavity. It is only suitable for isolated abscess or liver abscess and adhesion to the abdominal cavity near the liver surface. Incision restriction is revealed, and other abscesses or intra-abdominal infection sources in the liver are easily missed and are currently used less. The other is transabdominal abscess incision and drainage. Since the clinical application of antibiotics, this method has replaced the extraperitoneal route. Usually under the costal margin or median incision into the abdomen and drainage of liver abscess, can simultaneously treat other lesions in the liver and intra-abdominal infection.

Anesthesia and preoperative preparation

1. Anesthesia
General anesthesia plus continuous epidural anesthesia.


2. Preoperative preparation
Actively improve the general condition before surgery, strengthen nutrition, appropriate transfusion, correct anemia and water and electrolyte imbalance, and should apply large doses of effective antibiotics or anti-amebic drugs for different types of liver abscess; in addition, should pass the physical Check B-ultrasound or CT examination, try to identify the location of the abscess in order to choose the surgical approach and surgical methods.

Indication

1. Other therapies are invalid.
2. There are cases of primary infection in the abdominal cavity.
3. The pus is thick, the septum is separated, and the abscess is unable to puncture the drainage.

Contraindication
Old and frail, with severe heart disease, can not tolerate the incision.

Surgical procedure
Anterior hepatic abscess incision and drainage surgery:

1. The oblique incision under the right costal margin, after entering the abdominal cavity through each layer of the abdominal wall, explore the liver and identify the abscess.
2. Discharge pus, pus to send bacterial culture and Gram stain, gently separate the interstitial tissue in the abscess, absorb the pus.
3. Remove the necrotic tissue in the abscess, and drain the tube in the abscess.
4. Abdominal wall incision sutured layer by layer.

If the abscess is located on the anterior side of the right lobe of the liver and is intimately attached to the anterior peritoneum, the anterior extraperitoneal approach can also be used to drain the pus. An abscess located at the top or posterior side of the right hepatic lobe can be treated with a posterior extraperitoneal abscess.

Postoperative complications
Abdominal infection, sinus non-healing, bile fistula, bleeding.

Postoperative care

1. Take the semi-recumbent position and keep the circulation smooth.
2. Continue with effective anti-infective or anti-amebic treatment.
3. Continue to support the therapy.
4. If the gauze is filled with hemostasis during operation, the gauze will be pulled out in 3 to 5 days after surgery, and the dressing will be replaced.

Precautions

1. When separating the fibrous septal tissue in the abscess with your fingers, do not forcibly tear it if you encounter a strip.
2. Liver abscess caused by biliary stones, stenosis and other diseases, while the abscess is incision and drainage, the common bile duct should be explored to relieve the primary disease in the biliary tract. In the determination of aphid liver abscess, it is necessary to explore the common bile duct, take out the aphids, and at the same time do the common bile duct drainage.
3. If the liver abscess has been worn through the thoracic cavity, a closed thoracic drainage must be performed at the same time.
4. If the abscess is frequent, an intraoperative B-ultrasound should be performed to avoid missing the abscess that is not drained.

Postoperative diet
Intestinal or parenteral nutrition support is given early after surgery.