Laparoscopic Cholecystectomy In Children

WHAT YOU SHOULD KNOW:

Laparoscopic cholecystectomy is surgery to remove your child's gallbladder. During this surgery, small incisions are made in your child's abdomen. A small scope and special tools are inserted through these incisions. A scope is a flexible tube with a light and camera on the end.

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

RISKS:

• Problems may happen during your child's laparoscopic cholecystectomy that may lead to an open surgery. His stomach, liver, intestines, blood vessels, or nerves may get injured during the surgery. This may cause too much bleeding and a large amount of blood loss. Your child could also have trouble breathing or an infection during or after surgery. The gas used during his surgery may cause shoulder or chest pain for 1 to 2 days after his surgery.
  
  
• Without treatment, the symptoms of cholecystitis and cholelithiasis may get worse. The bile flow may get blocked or the gallbladder tissue may die. This may lead to serious medical problems, such as peritonitis (infection of abdominal wall membrane) and sepsis (blood infection).

WHILE YOU ARE HERE:

Before your child's surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that your child may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your child's medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done to your child. Make sure all of your questions are answered.
  
  
• Emotional support: Stay with your child for comfort and support as often as possible while he is in the hospital. Ask another family member or someone close to the family to stay with your child when you cannot be there. Bring items from home that will comfort your child, such as a favorite blanket or toy.
  
  
• Enema: Your child may need to have an enema before his surgery. This is liquid put into his rectum to help empty his bowel.
  
  
• IV: An IV is a small tube placed in your child's vein. Caregivers use the IV to give your child medicine or liquids.
  
  
• Preoperative care: Medicine may be given to help your child relax. Your child will be taken to the room where the procedure or surgery will be done.
  
  
• General anesthesia: General anesthesia is medicine that puts your child to sleep and keeps him comfortable during surgery. The medicine may be given through an IV, a mask, or a tube placed in his mouth.
  
  
• Foley catheter: This is a tube that may be put into your child's bladder to drain his urine into a bag. The bladder is an organ where urine is kept. The foley catheter is usually taken out shortly after the surgery.

During your child's surgery:

• Your child's abdomen will be cleaned with soap and water. Sheets will be put over him to keep the surgery area clean.
  
  
• During your child's surgery, a small incision is made near his belly button to insert the laparoscope through. Caregivers will insert other instruments by making 2 to 3 smaller incisions at different places on your child's abdomen. The abdomen is then inflated with a gas (carbon dioxide) to make the abdomen swell. This lifts the abdominal wall away from the internal organs and allows your child's caregiver more space to work. Clips are used to separate your child's gallbladder and bile ducts from where they are attached.
  
  
• The gallbladder, bile duct, and blood vessels are tied and cut off using scissors. The abdomen is then thoroughly irrigated (washed out). The incisions are closed with stitches or surgical tapes and covered with bandages. A T-tube (thin rubber tube) connected to a small bag may be placed to drain bile from your child's abdomen.

After your child's surgery:

• Your child may be taken to a recovery room until he is fully awake. The ET tube may be removed after he is awake and can breathe well on his own. A tube going into his stomach may remain for a while. Caregivers will watch your child closely for any problems. When caregivers see that your child is okay, he will be taken back to his hospital room.
  
  
• A caregiver may remove the bandages soon after your child's surgery to check his wound, tubes, or drains. Ask your child's caregiver for more information about ways to prevent bleeding and take care of your child's tubes and incision.

• Activity: Your child's caregiver will tell you when it is okay for your child to get out of bed. Call his caregiver before letting him get out of bed for the first time. If he ever feels or looks weak, have him lie down right away. Then call your child's caregiver.
  
  
• Diet: Your child may be able to eat when bowel sounds (stomach growling) are heard. Your child's caregiver will listen to his abdomen for bowel sounds using a stethoscope. Small amounts of water are usually given first and then other liquids (apple juice, breast milk, or formula milk). If your child does not have problems after drinking liquids, caregivers may then let him eat soft foods. Some examples of soft foods are applesauce, mashed fruits or vegetables, or other baby foods.
  
  
• Medicines: Your child may need any of the following:
  
  
  • Antibiotics: This medicine is given to help prevent or treat an infection caused by bacteria.
    
    
  • Anti-nausea medicine: This medicine may be given to calm your child's stomach and control vomiting (throwing up). Your child may have an upset stomach after surgery or taking pain medication.
    
    
  • Pain medicine: Your child may need medicine to take away or decrease pain. Know how often your child should get the medicine and how much. Watch for signs of pain in your child. Tell caregivers if his pain continues or gets worse. To prevent falls, stay with your child to help him get out of bed.
  
  
• Monitoring: Caregivers may check for your child's pulses on his arms or wrists. This helps caregivers learn if he has problems with blood flow after his surgery. Your child may also have any of the following:
  
  
  • Blood tests: A sample of your child's blood may be collected and sent to the lab for different tests. These may include liver profile and blood counts.
    
    
  • Intake and output: Caregivers may need to know how much liquid your child is getting and urinating. Your child may need to urinate into a container in bed or in the toilet. A caregiver will measure the amount of urine. If your child wears diapers, a caregiver may need to weigh them. Do not throw away diapers or flush urine down the toilet before asking a caregiver.
    
    
  • Vital signs: Caregivers will check your child's blood pressure, heart rate, breathing rate, and temperature. They will also ask you or your child about his pain. These vital signs give caregivers information about your child's current health.
  
  
• Oxygen: Your child may need oxygen if his blood oxygen level is lower than it should be. Oxygen will help your child breathe easier. Your child may get oxygen through small tubes placed in his nostrils, or through a mask. He may instead be placed in an oxygen tent. Never take off your child's oxygen tubes or mask or remove him from the tent without asking his caregiver first.
  
  
• Tubes and drains:
  
  
  • Drains: These are thin rubber tubes put into your child's skin to drain fluid from around his incision. The drains are taken out when the incision stops draining.
    
    
  • T-tube: A thin rubber tube may come out of your child's abdomen after surgery. This tube drains bile onto a bandage or into a small bag. The T-tube is removed when there is very little bile draining from the tube.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.