There are two common causes of gallstone disease in children and these occur in roughly equal proportions. The first cause is in children who have increased breakdown of their red cells such as in sickle cell disease, thalassemia, or spherocytosis. These diseases often run in families and so people already know about them. Because the red blood cells are being broken down at a higher rate the bilirubin that is one of the building blocks of the red blood cell can accumulate in the gallbladder causing bilirubinate stones. These stones can occur at any age even in very young children.
The second common cause of gallstones in children are cholesterol stones. There is often a family history of gallstones and it affects teenage girls more often than boys. Gallstones can present in a number of ways but usually present with abdominal pain. This pain can be central or right sided and some children describe the pain as going around to their back. It can be bought on by meals, especially meals with a high fat content. A number of children with gallstone disease already have very little fat in their diet. They avoid fat because they know that this can bring on the symptoms. More serious problems caused by gallstones is when they escape from the gallbladder into the common bile duct. Here they can cause an obstruction and the child may become jaundiced or they could cause an episode of pancreatitis. In symptomatic gallstones there is a strong recommendation for laparoscopic cholecystectomy. This is done, exactly as it is in adults, via a keyhole technique. Classically the children stay either 1 or 2 nights in hospital and then are right to go home.
Over the first 1 – 2 days, starting with clear fluids the child is progressed back to a normal diet. The small laparoscopy holes are closed with dissolving stitches and then covered with a clear waterproof dressing so nothing further needs to be done for these. We recommend no baths or showers for 2 days and then normal baths or showers. The dressings will then fall off at some stage of their own accord. Tiredness can be significant after this operation so we recommend at least 1 week off school and then a graduated return, possibly starting with half days. Return to all normal activities about a week after surgery but probably wait for 3 weeks before returning to high energy activities and sports.