Laparoscopic cholecystectomy.

Cholelithiasis has been considered infrequent in the child, but its reported incidence has increased during the past 2 decades. Several risk factors for the development of biliary calculi, including prolonged parenteral nutrition, gallbladder stasis, ileal resection, and hemolytic disease, are peculiar to children. Most gallstones in children are thought to develop from hemolytic conditions; however, the increase in gallstones seen in the past 2 decades is more likely due to an increase in nonhemolytic cholelithiasis. With the increased incidence of cholelithiasis in the pediatric patient, cholecystectomy will become a more common procedure. Laparoscopic cholecystectomy already has become the surgical technique preferred for most adults and is rapidly gaining acceptance in children. Twenty-five children have undergone laparoscopic cholecystectomy since June 1990 without intraoperative or postoperative complications. Cholangiography was possible in 16 patients. However, because of the size of the pediatric patient, essential modifications have been made in the procedure to adapt it to the infant and child.