Consumer Information

Laparoscopic Cholecystectomy In Children

WHAT YOU SHOULD KNOW:

Laparoscopic (lapah-ROS-ko-pik) cholecystectomy (ko-le-sis-TEK-to-me) is surgery to treat gallbladder and bile duct diseases. These diseases include cholecystitis (swelling of the gallbladder) and cholelithiasis (stones in the gallbladder or bile ducts). The gallbladder is a pear-shaped organ located under the liver on the right side of the upper abdomen (belly). It stores bile that comes from the liver and helps in the digestion of food. Bile is carried by the bile duct to the intestines. If left untreated, gallstones may block the flow of bile and cause more swelling, infection, and abdominal pain.
In a laparoscopic cholecystectomy, small incisions (cuts) are made in your child's abdomen. Caregivers will insert special tools and a laparoscope through these incisions to do the surgery. A laparoscope is a long metal tube with a light and tiny video camera on the end. This gives caregivers a clear view of the abdominal area while watching the images on a monitor. During this surgery, your child's gallbladder and gallstones will be removed (taken out). With a laparoscopic cholecystectomy, your child's cholecystitis and cholelithiasis may be cured and the symptoms they cause relieved.

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat 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 while having 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 special 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). Ask your child's caregiver if you are worried or have questions about your child's surgery, medicine, or care.

GETTING READY:

The week before your child's surgery:

Ask a family member or friend to drive you and your child home after his surgery. Try not to drive yourself and your child home.
Ask your child's caregiver if you need to stop giving any of your child's present medicines.
Ask your child's caregiver before giving your child any over-the-counter or herbal medicine or supplement. If you regularly give these medicines or supplements, tell your child's caregiver.
Dye may be used during your child's surgery to help caregivers see the gallbladder and bile duct better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may also be allergic to this dye. Tell your child's caregiver if your child is allergic to any of these.
Your child may need to have abdominal or chest x-rays, ultrasound, or blood, urine, or stool tests. Other tests may also be needed, such as a liver and gallbladder scan or endoscopic retrograde cholangiopancreatography (ERCP). Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.

The night before your child's surgery:

Ask caregivers about directions for eating and drinking.
Your child's bowel may need to be emptied and cleaned out before the surgery. Caregivers may give him a liquid medicine called an enema. This will be put into his rectum (rear end) to help empty his bowel. Your child's caregiver will teach you how to do this.
Your child may be given a medicine to help him sleep.

The day of your child's surgery:

Write down the correct date, time, and location of your surgery.
Ask your child's caregiver before giving any medicine on the day of your child's surgery. Bring all the medicines your child is taking, including the medicine bottles, to the hospital.
Have your child wear socks to help him stay warm.
If your child is staying in the hospital after his surgery, bring his personal belongings with you. These may include his clothes, feeding materials, or toys.
Caregivers will insert an intravenous tube (IV) into your child's vein. A vein in the arm is usually chosen. Through the IV tube, he may be given liquids and medicine.
A nasogastric (NG) or orogastric (OG) tube may also be inserted into your child's nose or mouth and into his stomach. This tube keeps air and fluid out of the stomach during surgery.
An anesthesiologist may talk to you before your child's surgery. This caregiver may give your child medicine to make him sleepy before the surgery.
You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your child's caregiver permission to do the surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.

TREATMENT:

What will happen:

Your child may be given medicine to help him relax or make him drowsy. He will be taken on a cart to the operating room and then moved onto a special bed. Soap and water will be used to clean your child's abdomen. Caregivers may give a general anesthesia to keep him asleep during surgery. An endotracheal (ET) tube connected to a breathing machine may be put into his mouth. This will go down the windpipe to keep his airway open and help him breathe during his surgery. A catheter may be inserted to drain your child's urine.
During your child's surgery, a small incision will be 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 his abdomen. The abdomen will then be 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 may be used to separate his gallbladder and bile ducts from where they are attached.
A special device may be used to suck up the bile and other contents of the gallbladder. The gallbladder, bile duct, and blood vessels will be tied and cut off using scissors. The abdomen will then be thoroughly irrigated (washed out). The incisions may be closed with stitches (threads) 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 OK, 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.

Waiting room: This is a room where you and your family can wait until your child is ready for visitors after surgery. Your child's caregiver will find you there to let you know how the surgery went. If you or your family leave the hospital, leave a phone number where you can be reached.

CONTACT A CAREGIVER IF:

You cannot make it to your child's surgery appointment on time.
You have a fever (increased body temperature).
Your child is irritable and crying more than usual.
Your child's skin is itchy, swollen, or has a rash.
You have questions or concerns about your child's surgery.

SEEK CARE IMMEDIATELY IF:

Your child has more jaundice (yellowing of the skin or the whites of the eyes) than before.
Your child has trouble breathing or his heart beats faster.
Your child is not able to eat or drink, or is urinating less or not at all.
Your child's abdomen becomes tender and hard.
Your child's vomit (throw up) has blood or bile in it.
Your child's signs and symptoms are getting worse.

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.

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