WOFAPS 2025 8th World Congress of Pediatric Surgery

Carlos Garcia-Hernandez, Lourdes Carvajal-Figueroa, Ariadna Alvelais-Arzamendi, Carlos Aguilar-Gutierrez

Universidad Nacional Autónoma de México

Introduction: Gallbladder disease is uncommon in children but is increasingly diagnosed. In some cases, adhesions from prior abdominal surgery may hinder standard infundibular dissection during laparoscopic cholecystectomy. The fundus-first (top-down) technique offers a safe alternative for retrograde dissection in these scenarios.

Case Series: We present five pediatric cases of calculous cholecystitis in patients with complex surgical histories.

· Case 1: 12-year-old female with intussusception and multiple bowel surgeries. Presented with 2 years of colicky pain and vomiting. Underwent fundus-first cholecystectomy (75 min, 40 mL blood loss). Oral intake at 18 hours; discharged after 4 days. No complications, 2-year follow-up.

· Case 2: 6-year-old female with NEC and prior resections. Six-month history of pain and vomiting. Surgery lasted 65 minutes with 20 mL blood loss. Intake at 12 hours; discharged after 3 days. No complications at 3 years.

· Case 3: 16-year-old female with enterocolitis and bowel surgeries. Four-year history of intermittent pain. Surgery lasted 45 minutes, 30 mL blood loss. Discharged after 3 days. No complications at 1 year.

· Case 4: 13-year-old female with Hirschsprung’s disease. Three-year history of pain. Surgery lasted 65 minutes, 20 mL blood loss. Discharged after 4 days. No complications at 6 months.

· Case 5: 9-year-old male with pyloric stenosis and mucosal perforation. One-year history of pain. Surgery lasted 75 minutes, 40 mL blood loss. Discharged after 3 days. No complications at 2 years.

Conclusion: Fundus-first laparoscopic cholecystectomy is a safe and effective alternative in pediatric patients with complex surgical histories and limited infundibular access.