A cholecystectomy is a surgery to remove the gallbladder. Cholecystectomy is one of the most common operations performed in adults, and it is becoming much more frequent operation in children as well.

The pediatric general surgery team at Johns Hopkins All Children’s in St. Petersburg, Florida, is experienced in treating children who need a cholecystectomy.

A physician may recommend a cholecystectomy for several conditions including:

• stones in the gallbladder (cholelithiasis)
• inflammation of the gallbladder due to stones (cholecystitis)
• ineffectiveness of the gallbladder (biliary dyskinesia)
• stones that have moved into the biliary system and are causing symptoms (gallstone pancreatitis)

Gallstones are very common in Hispanic, Native American and Caucasian populations. It is relatively uncommon in African Americans. People with certain hematologic conditions such as sickle cell anemia, hereditary spherocytosis and thalassemia are at particular risk for developing gallstones.

Symptoms of Gallstones in Children

Common symptoms of gallstones in children and adolescents include:

• Pain in the upper abdomen on the right side or towards the middle
  • This pain may travel to the back or to the right shoulder
  • This pain may also be associated with nausea and vomiting
  • This pain may come on after eating a meal high in fat
• If a stone is blocking a duct, fever may develop or the eyes may turn yellow - in this case, seek immediate medical attention

Gallstones are typically diagnosed with an ultrasound, which allows your child's provider to look at the liver and bile duct system to determine if there are stones in the gallbladder. Ultrasound exams are noninvasive and not painful. If more information is needed, a gallbladder scan or MRI may be recommended. Blood tests may also be recommended to look for any complicated findings of the gallstones, such as blockage of the liver or inflammation of the pancreas.

If your child has gallstones but is not experiencing symptoms such as pain or vomiting, treatment may not be necessary. It is important to monitor for any changes and seek medical evaluation if symptoms develop.

When gallstones are causing symptoms, the most effective treatment is surgical removal of the gallbladder.

Our Approach to Diagnosis and Treatment

Gallbladders are most often removed using minimally invasive surgery (MIS), also known as laparoscopic cholecystectomy. Gallbladder removal is performed under general anesthesia. During a laparoscopic cholecystectomy, a surgeon typically makes four small incisions on the abdomen and inserts a high-definition camera (called an endoscope) and thin instruments into the abdomen to remove the gallbladder.

A newer, cutting-edge method of performing surgery called single-incision surgery is now being used to remove the gallbladder in select patients. In this approach, instead of four incisions, the surgeon makes one incision hidden in the belly button and removes the gallbladder in an otherwise similar way to the standard four-incision approach.

Compared to traditional open surgery, they typically result in less pain and minimal scarring.

In some cases, an open surgical approach—using an incision beneath the ribs—may be necessary. This is more likely if there is significant scarring, inflammation, bleeding, or unusual anatomy that makes a minimally invasive approach unsafe. In all cases, your child’s care team will thoroughly explain the recommended procedure to you and answer any questions you may have.

What to Expect

Our team will guide you and your child through each step of the process. This includes your child’s pre-operative consultation, anything you need to do to prepare for your child’s surgery, and what to expect the day of. Learn more about what happens before and on the day of your child’s surgery.

We also offer a number of other resources and support services for families. Learn more about some of the resources available to your family.

The operation itself lasts approximately one hour. Patients are given pain medication if they feel any discomfort and may go home the same day depending on their condition. It is common to have pain or discomfort at the incision sites and/or behind the right shoulder (due to the gas used to inflate the abdomen during surgery). Most patients feel much better after the first day and only require stronger pain medication the first one to two days following surgery.

Your child's surgeon will instruct you as to when your child may return to normal activities including physical education and sports. Your child will generally be seen in the surgeon’s office approximately two weeks following surgery. If you have any questions or concerns before this, please contact our office and the surgeon or our nurse practitioner or physician assistants will address your questions.

Resources for Families 

• Cholecystectomy Patient Information: From the Society of American Gastrointestinal and Endoscopic Surgeons
• Patient and Family Support: Helpful resources for families, including how to prepare for your child's surgery