Bile ("bile") is a viscous substance produced by the liver that contributes to digestion (especially of fats). Part of the bile is stored in the so-called gall bladder. At mealtimes, the gallbladder can contract and release additional bile into the duodenum for digestion. The color of the bile is green to yellowish, depending on the proportion of different bile pigments (so-called bilirubin and biliverdin).

Gallstones (cholelithiasis from the ancient Greek chole 'bile' and líthos 'stone') are deposits in the gallbladder caused by an imbalance of soluble substances in the bile. They are made up of different components: Cholesterol, bilirubin, bile salts and bile acids. If a gallstone is located in the gallbladder, this is known as cholecystolithiasis. If the stone is located in the bile duct, it is called choledocholithiasis.

Gallstones are common and in most cases do not cause any symptoms. They are often only discovered by chance during an ultrasound examination of the abdomen, but severe pain can occur if gallstones become trapped and obstruct the outflow of bile. Patients then sometimes complain of severe abdominal pain (so-called "colic", usually on the right under the ribs in the upper right abdomen). Inflammation of the gallbladder (cholecystitis) can also occur, as internal injuries to the gallbladder can lead to inflammation. Gallstones must then be surgically removed, which is nowadays performed by laparoscopy. Non-surgical options for the treatment of gallstones have not become established in view of the very low complication rate of surgery.

Gallstones occur much less frequently in children than in adults. In addition to known causes such as obesity and malnutrition, metabolic and haematopoietic disorders can also lead to the formation of gallstones in children. Gallstones in infants and small children are even rarer and are usually the result of other diseases and their treatment. However, the possibilities of minimally invasive surgery can also be used in this age group.

 

Technical terms
- Cholecystolithiasis: Gallstone disease of the gallbladder
- Cholecystitis: Gallbladder inflammation, usually due to gallstone disease
- Choledocholithiasis: Gallstone disease in the common bile duct
- Laparoscopic cholecystectomy: Minimally invasive removal of the gallbladder

Initial contact is always made by means of an outpatient consultation in our pediatric surgery outpatient clinic (see below for contact details). The treatment options will be presented and your questions will be discussed in detail. Please bring all available examination results (e.g. ultrasound findings, reports from a possible gastrointestinal endoscopy) to the first outpatient information meeting. The ultrasound examination usually provides reliable evidence of the stones. We do not repeat preliminary examinations that have already been carried out, but only supplement them if necessary. If it is suspected that the gallstones are not only in the gallbladder, but have already migrated into the bile ducts, an endoscopy of the stomach and duodenum (ERCP) must be performed before an operation. Small stones in the bile ducts can then be removed immediately.

 

 

For most children with gallstones and typical symptoms, surgery is the method of choice. The gallbladder and all the stones are removed directly (in either case laparoscopically) via small abdominal incisions using a video camera or via a single incision (so-called single-port operation).

Cholecystectomy with three trocars ("multitrocar cholecystectomy")

The pediatric surgeon makes a small incision at the navel through which a thin tube (trocar) is inserted into the abdominal cavity. Air is blown into the abdominal cavity through the trocar and a camera is inserted (laparoscopy). This allows the entire abdomen to be inspected. Three further small (0.3 cm) incisions are then made in the upper right abdomen under visualization and further working channels (trocars) are inserted into the abdomen. The gallbladder is located and the blood vessels supplying it are "cooked" with an electric hook and finally the entire gallbladder is removed. The separated gallbladder is either removed directly via the trocar at the navel or (if it is very thickened or contains large stones, for example) placed in a special plastic bag and then pulled out through the navel. The small incision at the navel and the three small incisions in the upper abdomen are then closed again.

Cholecystectomy via a single access at the navel
(synonyms: "single-incision cholecystectomy", SILS, "single-port cholecystectomy")

In this surgical method, the pediatric surgeon inserts a special trocar (so-called "SILS port") into the abdomen via the navel. The SILS port consists of a flexible rubber sleeve with 3 openings for inserting the laparoscopic instruments. The principle of cholecystectomy is the same as for cholecystectomy with three trocars, with the only difference that the additional trocars or skin incisions are omitted. As "only" the incision in the center of the navel is visible after the operation, some authors refer to this method as "scarless" surgery. Strictly speaking, a scar still remains, but it is usually cosmetically less prominent or more visible than with a cholecystectomy with three trocars.

Both procedures are performed in our Clinical Department with a high level of patient satisfaction. We will discuss which procedure is most suitable for your child with you before the operation during the detailed surgical consultation.

After the operation, your child will initially remain in the recovery area, where you will be able to sit at the bedside again. You will then be transferred to the normal ward. A few hours after the operation, your child will usually be able to eat again. After an uncomplicated cholecystectomy, an inpatient stay of 1-2 days in hospital is usually sufficient.

As a rule, we do not require patients to return for a follow-up examination. As we only use stitches that dissolve on their own, the first post-operative check-ups after discharge are carried out by your pediatrician. However, if any questions remain unanswered or if we consider a follow-up examination to be appropriate in individual cases, you can come back to us at any time.