The need to have one’s gallbladder removed is generally due to the formation of gallstones. Gallstones form when there is an imbalance in the components in the bile that is normally stored in the gallbladder. For most people, there is no known reason why gallstones develop. Nevertheless, there are diseases that can predispose your child to form gallstones. Children who have problems with blood cells being broken down easily such as can happen in spherocytosis and sickle cell anemia have increased incidence of gallstone formation.
Gallstones can be asymptomatic in that they are present but cause no symptoms. Gallstones can intermittently block the connection between the gallbladder and the common bile duct which can cause pain.
Patients may have nausea and vomiting associated with this blockage. The pain is generally in the upper abdomen and can be localized to the right upper abdomen. These symptoms often resolve within a relatively short time, but usually mean that the gallbladder should be removed.
Acute and chronic inflammation of the gallbladder can occur if there is persistent obstruction of the connection between the gallbladder and the common bile duct. This is called cholecystitis. This blockage of bile flow can lead to inflammation and potential infection of the gallbladder. The symptoms are similar to that of symptomatic gallstones with the addition of fever and the persistent pain. Occasionally, the gallstone can lodge in the bile duct connecting the liver to the intestine and block all bile flow resulting in jaundice (yellowing of the skin).
The easiest way to diagnose gallstones is by performing an ultrasound test. Occasionally, gallstones can be seen on plain x-ray and CT scans. Once gallstones are found, they rarely resolve spontaneously. In general, if the patient has pain due to the gallstones, the best treatment is surgical removal of the gallbladder.
Surgery for removal of the gallbladder is accomplished under general anesthesia. Most patients can be admitted the morning of surgery. Occasionally, your child may need to be admitted a day or two before surgery for preoperative preparation. This can be necessary in children with sickle cell anemia who need to be transfused and given fluids before surgery.
The minimally invasive technique for removal of the gallbladder is called laparoscopic cholecystectomy. This means that several small incisions (1/4 – 1/2 inch) are used to place a telescope and other small instruments into the abdomen. This is done instead of a large incision in the right upper abdomen which was traditionally done prior to the development of laparoscopic techniques. The advantages of the laparoscopic technique are a shorter hospitalization, diminished pain, better cosmetic result and earlier return to full physical activity. Rarely, the gallbladder anatomy is such that the procedure needs to be converted to an open operation. This happens when the surgeon does not feel it is safe to do the operation with laparoscopy. This can happen when the gallbladder anatomy is not routine, when there are bleeding problems, or when there is so much inflammation in the gallbladder that it is hard to identify the correct anatomy.
During the operation, the surgeon may or may not perform an intraoperative cholangiogram. For this study, a catheter is placed in the gallbladder and dye is injected into the common bile duct to ensure that there is no other obstruction. If there is an obstruction to the common bile duct, then the surgeon may elect to explore the bile duct either with the laparoscopic equipment or with an open operation. Another option would be to leave the stones for a gastroenterologist to remove using an endoscope passed through the mouth and into the first part of the small intestine. With the endoscope in the small intestine, the opening of the common bile duct into the intestine is opened widely to allow extraction of the gallstones.
Complications from the laparoscopic cholecystectomy are infrequent. They include infection, bleeding, injury to the intestine and bile duct.
Your child generally will be discharged home on the first day after surgery. Most children can return to school within a week after surgery and are ready for all physical activities within two weeks.
Article and graphics adapted from O'Neill: Principles of Pediatric Surgery. © 2003, Elsevier.