Gallstones

We have treated many children with gallstones at Seattle Children’s. Our surgeons have extensive experience in performing the most common operation to remove the gallbladder, called laparoscopic cholecystectomy (pronounced koh-leh-sist-EKT-uh-mee). We also have extensive experience in dealing with the possible complications of gallstone disease, such as problems with the liver or pancreas.

When you come to Seattle Children’s, you have a team of people to care for your child before, during and after surgery. Along with your child’s surgeon, you are connected with nurses, dietitians, child life specialists and others. We work together to meet all of your child’s health needs and help your family through this experience.

Since 1907, Seattle Children’s has been treating children only. Our team members are trained in their fields and also in meeting the unique needs of children. For example, the doctors who give your child anesthesia are board certified in pediatric anesthesiology. This means they have extra years of training in how to take care of kids. Our child life specialists know how to help children understand their illnesses and treatments in ways that make sense for their age.

The most common symptom is pain in the upper belly (abdomen). This pain gets worse and lasts for at least 30 minutes. It may last for as long as a few hours. Your child may feel that the pain is centered on the upper right side of the belly.

It is difficult for most children younger than about 9 or 10 years old to pinpoint their pain. They may seem vague about where they hurt. But some older children or young adults may describe their pain as:

• Centering in the right upper or middle upper belly
• Spreading to the back or between the shoulder blades
• Feeling sharp, cramping or dull
• Going away, then coming back again (recurrent)
• Happening just after eating a meal
• Getting worse after eating fatty or greasy foods

If a gallstone blocks a duct, your child may also have some or all of these symptoms: 

• Nausea
• Vomiting
• Fever
• Jaundice, a yellowish tint to the skin and eyes

At the time of surgery, we will give your child medicine to make them sleep without pain during the operation (general anesthesia). Removing the gallbladder takes about 1 to 2 hours. Your child will be in the recovery room for another hour.

Less invasive surgery

In most cases, surgeons can remove the gallbladder using laparoscopic surgery, also called minimally invasive surgery. This means they make several small cuts (incisions) in the belly instead of one large incision (open surgery). Surgeons insert a thin, lighted tube with a camera and their surgical instruments through these small incisions. Then they snip the gallbladder free and remove it through one of the openings.

The advantage of laparoscopic surgery is that surgeons don’t have to cut through the stomach muscles. Children recover faster.

Open surgery

On rare occasions, children need to have open surgery (one large incision) instead of laparoscopic surgery. This may be the case if your child has had other abdominal operations in the past. If so, your child’s surgeon will discuss it with you.

During the gallbladder removal operation, the surgeon may perform a cholangiogram, a study of the bile ducts. This study is not always necessary, but it helps doctors make sure that gallstones have not fallen out of the gallbladder and into the main bile duct. If the study does show gallstones in the main bile duct, the surgeon will try to remove them. Because the bile ducts of children are usually very small, this can be very difficult to do using laparoscopic techniques.

Removing gallstones outside the gallbladder

In some cases, a child may need an ERCP (endoscopic retrograde cholangiopancreatography, pronounced koe-LAN-jee-oh-PAN-kree-ah-TOG-rah-fee) to remove gallstones that have fallen out of the gallbladder. In an ERCP, the surgeon passes a lighted scope through the child’s mouth, past the stomach and into the upper small intestine (duodenum). This way, the doctor can see the bile duct entering the intestine. Small instruments can be passed through the scope and used to remove the gallstones. An ERCP often helps doctors avoid doing a larger operation on your child. If your child needs an ERCP, it most likely will be done on a different day from the gallbladder removal surgery.

After laparoscopic surgery, you can expect your child to stay in the hospital for 1 to 2 days. Once your child is home, you may need to limit activity for several days.

After open surgery, you can expect your child to stay in the hospital for 2 to 7 days. You may need to limit your child’s activity for several weeks while they recover.

In either case, we will give your child pain medicine to make them comfortable. You’ll need to keep the incisions clean and dry until they heal. The surgery team will teach you how to do this and tell you about any activity limits.

About 2 to 3 weeks after surgery, your child will need to see the surgeon for a follow-up visit. The surgeon will make sure the incision is healing and your child is recovering well.