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Successful laparoscopic cholecystectomy in a child with upper transverse scarring: report of a case
K Nakajima1, Y Fukui, S Kamata
1Department of Pediatric Surgery, Osaka University Medical School, Suita, Japan.
Insights
Laparoscopic cholecystectomy is safe for children with prior abdominal surgery. Adhesions were managed to enable the procedure, showing feasibility in complex pediatric cases.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
Background:
- Cholelithiasis in pediatric patients necessitates surgical intervention.
- Previous major intra-abdominal surgery can present challenges for subsequent laparoscopic procedures due to adhesions.
Observation:
- A 4-year-old boy with a history of neonatal intestinal surgery and a significant transverse abdominal scar required laparoscopic cholecystectomy for cholelithiasis.
- Intraoperative findings included adhesions beneath the abdominal scar, requiring careful adhesiolysis.
Findings:
- Laparoscopic cholecystectomy was successfully completed using standard techniques and 5-mm titanium clips.
- Adhesions were sharply divided and coagulated, with placement of additional ports as needed during adhesiolysis.
Implications:
- This case demonstrates the feasibility and safety of laparoscopic surgery in pediatric patients with a history of extensive intra-abdominal surgery.
- Careful adhesiolysis and strategic port placement can overcome challenges posed by adhesions in pediatric laparoscopic procedures.
Abstract:
Laparoscopic cholecystectomy (LC) was safely performed for cholelithiasis in a 4-year-old boy who had a long transverse operative scar in the upper abdomen as a result of intestinal surgery performed during the neonatal period. The adhesions beneath the scar were sharply divided and sometimes coagulated, and additional working ports were subsequently placed as the adhesiolysis proceeded. LC was performed in the usual fashion using 5-mm titanium clips, and his postoperative course was uneventful. This case report serves to demonstrate that laparoscopic surgery is feasible even for pediatric patients who have undergone previous major intraabdominal surgery.