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 after getting the approval from the institutional ethical committee and 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 computerised randomisation 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