Laparoscopic Cholecystectomy In Children

WHAT YOU SHOULD KNOW:

Laparoscopic cholecystectomy is surgery to remove your child's gallbladder. The gallbladder stores liquid called bile. Bile helps your child's body digest fat. After surgery, your child's bile ducts will widen to hold the bile once held by his gallbladder. During the surgery, small incisions are made in your child's abdomen. A small scope and surgical tools are inserted through the 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:

• Your child may have pain in his abdomen and around his incisions. Any carbon dioxide gas that remains in your child's abdomen can rise and cause neck and shoulder pain. There is a small risk that your child's bile duct, liver, small intestine, or other organs could be damaged during surgery. Your child could bleed more than expected or get an infection. Your child's pancreas could become inflamed, which could cause abdominal pain, bloating, or vomiting. Bile or bowel movement in his abdomen can cause a severe infection or abscess. Your child's gallbladder may leak bile and gallstones before it is removed, or bile could leak into his abdomen after surgery.
  
  
• Your child may still have gallstones after surgery, and he may need a different procedure to remove them. During the operation, the laparoscopic surgery may need to be converted to open surgery. This means that a larger incision will be made in your child's abdomen.

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.
  
  
• 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.
  
  
• IV: An IV is a small tube placed in your child's vein. Caregivers use the IV to give your child medicine or liquids.
  
  
• Your child may be given antibiotics before surgery to help prevent infection.
  
  
• 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.
  
  
• After the anesthesia has put your child to sleep, he may need the following:
  
  
  • Foley catheter: This is a tube put into your child's bladder to drain his urine into a bag. Caregivers will remove the catheter as soon as possible to help prevent infection.
    
    
  • NG tube: This is also called a nasogastric tube. An NG tube is put down your child's nose and into his stomach. An NG tube keeps air and fluid out of the stomach during surgery. It is usually taken out shortly after surgery.

During your child's surgery:

Your child's abdomen will be cleaned. The surgeon will make between 1 and 4 small incisions on your child's abdomen or navel. He will insert the surgical tools and laparoscope into the incisions. The camera attached to the laparoscope will display images of your child's abdominal organs on a nearby monitor. The surgeon will fill your child's abdomen with carbon dioxide gas to make it swell. This allows him to see the organs better. It also gives him more room to move the surgical tools and laparoscope around. Your child's surgeon will search for and remove gallstones in and around his gallbladder. X-rays or ultrasound may be used during surgery to see the abdominal organs better or look for gallstones. The surgeon will carefully separate your child's gallbladder and remove it through an incision, usually the navel incision. The carbon dioxide will be released from his abdomen. Your child's surgeon may inject medicine into his abdomen or incisions to reduce his pain after surgery. The incisions will be stitched or closed with adhesive strips, then covered with bandages.

After your child's surgery:

Your child will be taken to a recovery room until he is fully awake. Caregivers will watch him for any problems. Do not let your child get out of bed until his caregiver says it is okay. Your child will probably stay in the hospital for 1 night or more.

• Medicines: Your child may need any of the following:
  
  
  • 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.
    
    
  • Antinausea medicine: This medicine may be given to calm your child's stomach and control vomiting. Your child may have an upset stomach after surgery or taking pain medication.
  
  

• Monitoring:
  
  
  • 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.
    
    
  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your child's skin record the electrical activity of his heart.
  
  
• Deep breathing and coughing: This is done to decrease your child's risk for a lung infection. He should take a deep breath and hold it for as long as he can. Deep breaths help open his airways. He should let the air out and then cough strongly. Your child may be given an incentive spirometer to help him take deep breaths. He should put the plastic piece in his mouth and take a slow, deep breath, then let the air out and cough. Help your child hold a pillow tightly against his incisions when he coughs to help decrease pain. Have him repeat this 10 times every hour.
  
  
• Activity: Your child's caregiver will tell you how soon your child should get out of bed and walk around after surgery. Follow directions about how much and how often your child should move around.
  
  
• Food and drink: Your child will begin with ice chips or clear liquids such as water, broth, juice, and clear soft drinks. If his stomach does not become upset, he may then be given soft foods, such as ice cream and applesauce. Once he can eat soft foods easily, he may slowly begin to eat solid foods.