Aim: This study aims to compare the effectiveness of percutaneous catheter drainage and percutaneous needle aspiration in the treatment of liver abscesses. The goal is to assess key outcomes such as hospital stay, time to abscess resolution, success rates, complication rates, and the need for additional procedures to determine the optimal treatment method. Materials and Methods: The study was conducted during November 2021 to July 2022 at Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, India. A total of 100 patients diagnosed with liver abscess, confirmed by imaging studies, were enrolled in a prospective, randomized study. Patients were randomly assigned to two groups of 50 each: Group A (catheter drainage) and Group B (needle aspiration). The primary outcomes measured included hospital stay duration, time for abscess resolution, and success rates. Secondary outcomes included complications and the need for additional procedures. Data were analyzed using SPSS software version 25.0, with statistical significance set at p < 0.05. Results: The baseline characteristics of patients were similar in both groups, with no significant differences in age, gender distribution, or abscess size. The mean hospital stay was 8.5 days for Group A and 9.1 days for Group B, with a non-significant p-value of 0.18. The time for abscess resolution was also similar, with 13.5 days for Group A and 14.2 days for Group B (p = 0.22). Ten percent of patients in Group A required additional procedures compared to 16% in Group B, though this difference was not statistically significant (p = 0.36). The complication rates were 6% in Group A and 12% in Group B (p = 0.28). Success rates were 98% for Group A and 94% for Group B, with a p-value of 0.80, indicating no significant difference. Conclusion: Both catheter drainage and needle aspiration are effective and safe treatments for liver abscess, with no significant differences in key outcomes. While catheter drainage may offer a slight advantage in reducing the need for additional procedures, needle aspiration remains a viable option, especially for smaller abscesses. The overall high success rates suggest that both methods can be tailored to individual patient needs.