Background:This study was intended to assess the effectiveness of percutaneous needle aspiration (PNA) and pigtail catheter drainage (PCD) in the treatment of liver abscess.Methodology: A prospective randomized comparative study conducted at the Department of Surgery. The inclusion criteria are patients with liver abscess who were older than 16 years with a cavity size of more than 5 cm or more than 60mL in volume. The study was conducted on 510 patients with liver abscess were included for the study. The patients with the signs & symptoms of liver abscess were admitted and detailed history and physical examinations were carried out. Certain laboratory investigations include – complete blood counts, renal function test, liver function test, prothrombin time, viral markers, blood culture and amoebic serology were taken. All the patients were randomly assigned into two groups using computerized randomization method. Results: The PCD group had statistically significant rate of duration of antibiotics need, days for clinical improvement and time for 50% reduction in abscess cavity and treatment success rate with comparable long-term outcomes.Conclusion: PCD is more efficient than PNA and can be used primarily in the treatment of both amoebic and pyogenic liver abscesses along with systemic antibiotics. PNA can be considered as an effective alternative when PCD cannot be performed due to unavoidable situations.