Backgrounds. Pyogenic liver abscess is a rare disease whose management has shifted toward greater use of percutaneous drainage. Surgery still plays a role in treatment, but its indications are not clear. Method. We conducted a retrospective study of pyogenic abscess cases admitted to our university hospital between 1999 and 2010 and assessed the factors potentially associated with surgical treatment versus medical treatment alone. Results. In total, 103 liver abscess patients were treated at our center. The mortality was 9%. The main symptoms were fever and abdominal pain. All of the patients had CRP > 6？g/dL. Sixty-nine patients had a unique abscess. Seventeen patients were treated with antibiotics alone and 57 with percutaneous drainage and antibiotics. Twenty-seven patients who were treated with percutaneous techniques required surgery, and 29 patients initially received it. Eventually, 43 patients underwent abscess surgery. The factors associated with failed medical treatment were gas-forming abscess and septic shock at the initial presentation . Conclusion. Medical and percutaneous treatment constitute the standard management of liver abscess cases. Surgery remains necessary after failure of the initial treatment but should also be considered as an early intervention for cases presenting with gas-forming abscesses and septic shock and when treatment of the underlying cause is immediately required. 1. Introduction Pyogenic liver abscess (PLA) remains a rare disease with a high risk of mortality, up to 19% [1–13]. In recent years, diagnosing PLA and the underlying cause of the abscess has been made easier by modern imaging modalities. PLA management has also changed, with percutaneous drainage and intravenous antibiotics being now considered safe and effective [7, 8, 12]. Even though a nonoperative interventional radiology approach has become the first therapeutic choice for PLA, surgical treatment is still necessary in some cases, although its proper indications remain unclear. Indeed, surgical drainage is associated with increased morbidity and mortality and is often only used as a salvage procedure in cases failed percutaneous treatment [10, 12]. The aim of our study was to retrospectively analyze our monocentric French series of PLA cases and to reappraise the place of surgery in modern PLA management using a recent occidental series. 2. Patients and Methods All of the adult patients treated for a PLA from 1990 to 2009 in the Departments of Infectious Disease, Gastroenterology, and Hepatobiliary Surgery at the University Hospital of Caen were
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