Laparoscopic fundus-first cholecystectomy in children with prior abdominal surgeries: a case series

Introduction: Gallbladder disease is increasingly diagnosed in children. In some cases, adhesions from prior abdominal surgeries may make the standard infundibulum-first dissection very difficult. The fundus-first (top-down) cholecystectomy technique offers an alternative in those cases. Case series...

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Main Authors: Carlos García-Hernández, Lourdes Carvajal-Figueroa, Sergio Landa-Juárez, Ariadna Anette Alvelais-Arzamendi, Carlos Aguilar-Gutierrez
Format: Article
Language:English
Published: Elsevier 2025-07-01
Series:Journal of Pediatric Surgery Case Reports
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Online Access:http://www.sciencedirect.com/science/article/pii/S2213576625000788
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author Carlos García-Hernández
Lourdes Carvajal-Figueroa
Sergio Landa-Juárez
Ariadna Anette Alvelais-Arzamendi
Carlos Aguilar-Gutierrez
author_facet Carlos García-Hernández
Lourdes Carvajal-Figueroa
Sergio Landa-Juárez
Ariadna Anette Alvelais-Arzamendi
Carlos Aguilar-Gutierrez
author_sort Carlos García-Hernández
collection DOAJ
description Introduction: Gallbladder disease is increasingly diagnosed in children. In some cases, adhesions from prior abdominal surgeries may make the standard infundibulum-first dissection very difficult. The fundus-first (top-down) cholecystectomy technique offers an alternative in those cases. Case series: We present five pediatric cases of calculous cholecystitis in patients with complex surgical histories. Case 1 was a 12-year-old female with a history of intussusception and multiple intestinal surgeries. She presented with 2 years of colicky pain and vomiting. She underwent a fundus-first cholecystectomy that took 75 min. Oral intake was started 18 hours after the operation and she was discharged after 4 days. She has had no complications at 2 years of follow-up. Case 2 was a 6-year-old female with a history of necrotizing enterocolitis (NEC) and bowel resection. She presented with a six-month history of abdominal pain and vomiting. The Fundus-first cholecystectomy took 65 minutes. Oral intake resumed 12 hours after the operation and she was discharged after 3 days. No complications at 3 years of follow up. Case 3 was a 16-year-old female with a history of enterocolitis and bowel surgeries. She presented with a four-year history of intermittent abdominal pain. The operation lasted 45 minutes and she was discharged after 3 days. No complications have been observed at 1 year of follow up. Case 4 was 13-year-old female with a history of Hirschsprung's disease. She presented with a three-year history of abdominal pain. The fundus-first cholecystectomy took 65 minutes. She was discharged after 4 days and has had no complications at 6 months o follow up. Case 5 was a 9-year-old male with a history of pyloric stenosis and mucosal perforation. He presented with a one-year history of abdominal pain. The fundus first cholecystectomy took 75 minutes, he was discharged after 3 days, and has had no complications at 2 years of follow up. Conclusion: Fundus-first laparoscopic cholecystectomy is a safe and effective alternative to a standard cholecystectomy in pediatric patients with complex surgical histories and limited infundibular access.
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spelling doaj-art-6ca81f8d64f04507b22814be1fd447642025-08-20T02:34:53ZengElsevierJournal of Pediatric Surgery Case Reports2213-57662025-07-0111810303310.1016/j.epsc.2025.103033Laparoscopic fundus-first cholecystectomy in children with prior abdominal surgeries: a case seriesCarlos García-Hernández0Lourdes Carvajal-Figueroa1Sergio Landa-Juárez2Ariadna Anette Alvelais-Arzamendi3Carlos Aguilar-Gutierrez4Corresponding author. Viaducto Rio Becerra, # 97 Col. Nápoles, 03810, Mexico City, Mexico; Curso de alta especialidad en Cirugía de Mínima Invasión, Hospital Infantil Privado, Universidad Nacional Autónoma de México, Mexico City, MexicoCurso de alta especialidad en Cirugía de Mínima Invasión, Hospital Infantil Privado, Universidad Nacional Autónoma de México, Mexico City, MexicoCurso de alta especialidad en Cirugía de Mínima Invasión, Hospital Infantil Privado, Universidad Nacional Autónoma de México, Mexico City, MexicoCurso de alta especialidad en Cirugía de Mínima Invasión, Hospital Infantil Privado, Universidad Nacional Autónoma de México, Mexico City, MexicoCurso de alta especialidad en Cirugía de Mínima Invasión, Hospital Infantil Privado, Universidad Nacional Autónoma de México, Mexico City, MexicoIntroduction: Gallbladder disease is increasingly diagnosed in children. In some cases, adhesions from prior abdominal surgeries may make the standard infundibulum-first dissection very difficult. The fundus-first (top-down) cholecystectomy technique offers an alternative in those cases. Case series: We present five pediatric cases of calculous cholecystitis in patients with complex surgical histories. Case 1 was a 12-year-old female with a history of intussusception and multiple intestinal surgeries. She presented with 2 years of colicky pain and vomiting. She underwent a fundus-first cholecystectomy that took 75 min. Oral intake was started 18 hours after the operation and she was discharged after 4 days. She has had no complications at 2 years of follow-up. Case 2 was a 6-year-old female with a history of necrotizing enterocolitis (NEC) and bowel resection. She presented with a six-month history of abdominal pain and vomiting. The Fundus-first cholecystectomy took 65 minutes. Oral intake resumed 12 hours after the operation and she was discharged after 3 days. No complications at 3 years of follow up. Case 3 was a 16-year-old female with a history of enterocolitis and bowel surgeries. She presented with a four-year history of intermittent abdominal pain. The operation lasted 45 minutes and she was discharged after 3 days. No complications have been observed at 1 year of follow up. Case 4 was 13-year-old female with a history of Hirschsprung's disease. She presented with a three-year history of abdominal pain. The fundus-first cholecystectomy took 65 minutes. She was discharged after 4 days and has had no complications at 6 months o follow up. Case 5 was a 9-year-old male with a history of pyloric stenosis and mucosal perforation. He presented with a one-year history of abdominal pain. The fundus first cholecystectomy took 75 minutes, he was discharged after 3 days, and has had no complications at 2 years of follow up. Conclusion: Fundus-first laparoscopic cholecystectomy is a safe and effective alternative to a standard cholecystectomy in pediatric patients with complex surgical histories and limited infundibular access.http://www.sciencedirect.com/science/article/pii/S2213576625000788Laparoscopic cholecystectomyFundus-first approachPediatric gallstonesPostoperative adhesionsCase series
spellingShingle Carlos García-Hernández
Lourdes Carvajal-Figueroa
Sergio Landa-Juárez
Ariadna Anette Alvelais-Arzamendi
Carlos Aguilar-Gutierrez
Laparoscopic fundus-first cholecystectomy in children with prior abdominal surgeries: a case series
Journal of Pediatric Surgery Case Reports
Laparoscopic cholecystectomy
Fundus-first approach
Pediatric gallstones
Postoperative adhesions
Case series
title Laparoscopic fundus-first cholecystectomy in children with prior abdominal surgeries: a case series
title_full Laparoscopic fundus-first cholecystectomy in children with prior abdominal surgeries: a case series
title_fullStr Laparoscopic fundus-first cholecystectomy in children with prior abdominal surgeries: a case series
title_full_unstemmed Laparoscopic fundus-first cholecystectomy in children with prior abdominal surgeries: a case series
title_short Laparoscopic fundus-first cholecystectomy in children with prior abdominal surgeries: a case series
title_sort laparoscopic fundus first cholecystectomy in children with prior abdominal surgeries a case series
topic Laparoscopic cholecystectomy
Fundus-first approach
Pediatric gallstones
Postoperative adhesions
Case series
url http://www.sciencedirect.com/science/article/pii/S2213576625000788
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