Laparoscopic cholecystectomy.

Historically, cholelithiasis in children was thought to develop secondary to hemolytic disease. Within the past 20 years, however, its incidence in children without hemolysis is being diagnosed more frequently. Laparoscopic cholecystectomy has become the procedure of choice for gallbladder removal in children. Many of the principles for this technique in children are similar to those in the adult population. Because of the patient's smaller size and more pliable abdominal wall, however, several improvements in technique have been developed. In addition, special precautions are necessary in children because of other unique characteristics. At Children's Hospital, Vanderbilt University Medical Center, 80 infants and children have undergone laparoscopic cholecystectomy since June 1990 without intraoperative or postoperative complications. Modifications in the operative technique used in these patients are detailed.