Modern strategy for the treatment of liver abscess: the role of minimally invasive interventions and a step-up approach

Objective: To analyze the evolution of surgical tactics for liver abscesses, systematize modern indications for various treatment methods, and present the concept of a step-up approach as the safest and most effective strategy. Materials and Methods: An analysis of literary sources on the topic of surgical tactics for liver abscesses was conducted from the PubMed, Cochrane Library, eLibrary and CyberLeninka databases for the period from 2020 to 2026. Results: Modern meta-analyses demonstrate the high efficacy of percutaneous catheter drainage (PCD), reaching 91.3%. This exceeds the results of needle aspiration, which reach 88.2%. PCD promotes faster clinical improvement, an average of 1.9 days, and significantly reduces the recurrence rate over six months (relative risk 0.44). An analysis of national databases revealed the following rates of use of various treatment methods: PCD - 38.8%, needle aspiration - 13.5%, open surgery - 6.7%, and 35.3% of patients receiving drug therapy alone. Mortality in modern studies has been reduced to 3.3%. A step-up approach is actively used, according to which treatment begins with the least invasive methods. Open surgery is performed only if these are ineffective. Conclusion: The current treatment strategy for liver abscesses is based on the use of minimally invasive techniques, among which catheter drainage has proven superior to needle aspiration. This staged approach minimizes surgical invasiveness and reduces complication rates and mortality. Further advances are driven by improved navigation technologies, consideration of antibiotic resistance, and individualized treatment strategies.