Laparoscopic cholecystectomy in a 4 year old boy

A 4 years old boy was brought with 3 day h/o pain in the abdomen, two episodes of vomiting, fever and burning micturition. The father mentioned that this was the third admission in hospital for similar problem in 6 months time. They brought with them an ultrasonogram report from previous hospitalization saying bilateral mild hydronephroses. The baby was somewhat anxious looking. Abdomen was diffusely tender, more marked in right upper quadrant. Ultrasonogram of whole abdomen revealed gallstone with no other abnormality. Urinalysis was normal. Blood picture was also normal. The baby was treated conservatively and discharged with oral medications. A repeat ultrasonogram after 15 days revealed the same picture. Then the parents were offered for laparoscopic cholecystectomy of their son and they've agreed. Under general endotracheal anesthesia laparoscopy was performed. We follow the French technique i.e. the surgeon stands between the legs and a single assistant on the left with monitor on right of head end. Supra-umbilical 10 mm port for camera and gallbladder retrieval, an epigastric port for gallbladder retraction, right loin and left upper quadrant working ports for the surgeon. The cystic duct was identified, dissected out and clipped and cut. We cauterize the small branches of cystic artery distal to the lymph node of lund without cutting the cystic artery and did the same in this case. Then the gallbladder was dissected out of its bed in the liver and retrieved through supra-umbilical port. Hemostasis checked and ports closed. Baby was allowed liquids after 4 hours and discharged the following morning.