TY - CHAP M1 - Book, Section TI - Gallbladder Disease A1 - Juang, David A1 - Holcomb, George W. A2 - Ziegler, Moritz M. A2 - Azizkhan, Richard G. A2 - Allmen, Daniel von A2 - Weber, Thomas R. PY - 2014 T2 - Operative Pediatric Surgery, 2e AB - Gallbladder disease in children can arise from a number of underlying conditions, but the disease is due to cholelithiasis in most cases. Cholelithiasis is usually classified as being either hemolytic or nonhemolytic in etiology.Gallbladder contractility can be assessed with radionuclide scanning during CCK injection. Most surgeons utilize a gallbladder ejection fraction of less than 35% as an indicator for cholecystectomy in a symptomatic patient. The normal ejection fraction approximates 75%.Real-time US has an accuracy of approximately 96% for gallbladder disease and is effective in determining hepatic and common bile duct involvement, the presence of thickening of the gallbladder wall, and any abnormalities in the liver or head of the pancreas.We recommend that patients with symptomatic gallbladder disease who are older than 3 years should undergo laparoscopic cholecystectomy. Younger patients, particularly infants, should be individualized.The laparoscopic approach has become the standard method for cholecystectomy in children for the past 20 years.For the majority of pediatric surgeons, the best option may be to perform a preoperative ERCP with sphincterotomy and stone extraction if stones are found preoperatively. If successful, the surgeon can then proceed with laparoscopic cholecystectomy.SSULS is being utilized more frequently, but when compared with traditional 3 and 4-port/incision laparoscopic surgery, the only advantage of SSULS appears to be cosmesis. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/10/15 UR - accesssurgery.mhmedical.com/content.aspx?aid=1100435675 ER -