This video demonstrate laparoscopic cholecystectomy in a five year old girl. Gallstone disease has been considered an uncommon entity in children and infants, but its incidence is reportedly increasing which may be attributed to widespread use of diagnostic imaging (ultrasonography). An apparently healthy 5 year old female child presented to our Outpatient department with chief complaint of recurrent abdominal pain. The episodes of pain were acute in onset and associated with vomiting. As per the complete examination and findings, a diagnosis of chronic calculous cholecystitis was made. A four port laparoscopic cholecystectomy was done. The incidence of gallstones in children in India has not been sufficiently studied. The incidence of gallstone disease in India was found to be 0.3% with the incidence in age group 0–10 being less than 0.1%. In contrast to adult gallstone disease, it has been found that there is no female preponderance in gallstone diseases of infancy. Also, the majority of children having increased haemoglobin turnover develop pigment stones only after 5 years of age. The probability of gallstone disease in infants and young children should not be ignored. Gall stones should always be considered as a differential diagnosis when young patients present with complaints of abdominal pain.

Laparoscopic cholecystectomy, the minimally invasive removal of the gallbladder, is a well-established and safe procedure in adults. In recent years, with advancements in pediatric minimally invasive surgery, this technique has also become a reliable option for children, including young patients as young as five years old. Although gallbladder disease is uncommon in children, conditions such as gallstones (cholelithiasis), biliary dyskinesia, or complications of hemolytic disorders may necessitate surgical intervention.

Indications for Surgery in Children

Gallbladder surgery in a 5-year-old child is usually recommended when the child experiences:

• Symptomatic gallstones causing abdominal pain

• Recurrent episodes of cholecystitis

• Gallbladder-related pancreatitis

• Hemolytic diseases such as sickle cell anemia leading to pigment stones

• Congenital or functional gallbladder disorders

Early diagnosis and timely intervention help prevent complications and improve the child’s quality of life.

Why Laparoscopic Cholecystectomy?

Laparoscopic cholecystectomy is considered the gold standard for gallbladder removal due to its minimally invasive nature. In pediatric patients, this approach offers several advantages:

• Smaller incisions with minimal scarring

• Reduced postoperative pain

• Lower risk of infection

• Faster recovery and early return to normal activities

• Shorter hospital stay, often 24–48 hours

Surgical Technique in Pediatric Patients

The procedure is performed under general anesthesia by a trained pediatric laparoscopic surgeon. Typically, 3 to 4 small ports are placed, adjusted according to the child’s size and anatomy. Carbon dioxide is used to create pneumoperitoneum at lower pressures suitable for children. The gallbladder is carefully dissected from the liver bed, with clear identification of the cystic duct and artery to ensure safety. Once detached, the gallbladder is removed through a small port incision.

Postoperative Care and Recovery

Most children recover remarkably well after laparoscopic cholecystectomy. Postoperative pain is usually mild and managed with oral medications. Children are encouraged to start oral intake within a few hours and resume light activities within a few days. Normal school activities can typically be resumed within one to two weeks.

Parents are advised to observe for signs such as fever, persistent pain, vomiting, or wound redness and report these to the surgeon promptly.

Safety and Outcomes

Multiple studies have demonstrated that laparoscopic cholecystectomy in children is safe and effective when performed by experienced surgeons. Complication rates are low, and long-term outcomes are excellent. Children generally adapt well to life without a gallbladder, with no significant dietary restrictions required in the long term.

Conclusion

Laparoscopic cholecystectomy in a 5-year-old child is a safe, minimally invasive, and effective procedure when indicated. With modern surgical techniques and expert pediatric care, children can expect excellent outcomes, minimal discomfort, and a rapid return to normal childhood activities. Early intervention and specialized surgical expertise play a crucial role in ensuring the best possible results for young patients.