Laparoscopic fundus-first cholecystectomy in children with prior abdominal surgeries: a case series

Introduction

Gallbladder disease is increasingly diagnosed in children. In some cases, adhesions from prior abdominal surgeries may make the standard infundibulum-first dissection very difficult. The fundus-first (top-down) cholecystectomy technique offers an alternative in those cases.

Case series

We present five pediatric cases of calculous cholecystitis in patients with complex surgical histories. Case 1 was a 12-year-old female with a history of intussusception and multiple intestinal surgeries. She presented with 2 years of colicky pain and vomiting. She underwent a fundus-first cholecystectomy that took 75 min. Oral intake was started 18 hours after the operation and she was discharged after 4 days. She has had no complications at 2 years of follow-up. Case 2 was a 6-year-old female with a history of necrotizing enterocolitis (NEC) and bowel resection. She presented with a six-month history of abdominal pain and vomiting. The Fundus-first cholecystectomy took 65 minutes. Oral intake resumed 12 hours after the operation and she was discharged after 3 days. No complications at 3 years of follow up. Case 3 was a 16-year-old female with a history of enterocolitis and bowel surgeries. She presented with a four-year history of intermittent abdominal pain. The operation lasted 45 minutes and she was discharged after 3 days. No complications have been observed at 1 year of follow up. Case 4 was 13-year-old female with a history of Hirschsprung's disease. She presented with a three-year history of abdominal pain. The fundus-first cholecystectomy took 65 minutes. She was discharged after 4 days and has had no complications at 6 months o follow up. Case 5 was a 9-year-old male with a history of pyloric stenosis and mucosal perforation. He presented with a one-year history of abdominal pain. The fundus first cholecystectomy took 75 minutes, he was discharged after 3 days, and has had no complications at 2 years of follow up.

Conclusion

Fundus-first laparoscopic cholecystectomy is a safe and effective alternative to a standard cholecystectomy in pediatric patients with complex surgical histories and limited infundibular access.