A liver abscess is a common disease prevalent in the tropical countries. Effective treatment involves appropriate antibiotics and draining the abscess cavity. Different modalities of percutaneous drainage of liver abscess are increasingly popular. We analysed the effectiveness of pigtail catheter drainage compared to percutaneous needle aspiration in managing liver abscesses. Methods and material This retrospective analytical study was carried out at a tertiary care teaching hospital in southern India. It included adults aged ≥18 years admitted and treated for liver abscess. Patients were categorized into three groups for analysis: Group A (conservative treatment), Group B (percutaneous needle aspiration), and Group C (pigtail catheter drainage). Results A total of 96 patients with liver abscesses were analyzed, with a predominance of males (93.75%). The mean abscess volume in Group C (330 ± 22.6 ml) was significantly higher than in Group A (110 ± 64.1 ml, p = 0.03) and Group B (151 ± 142.7 ml, p = 0.024). Hospital stay duration and residual abscess volume at discharge did not differ significantly between treatment groups. Notably, pigtail catheterization reduced hospital stay for abscesses >150 ml but prolonged it for abscesses <150 ml. Conclusion Percutaneous pigtail catheter drainage should be considered for managing liver abscesses. Specifically, its use in abscesses >150 ml showed improved clinical outcomes.