ABSTRACT
The main indication for cholecystectomy is the presence of symptomatic gallstones. These differ from those found in adults, which are largely mixed and cholesterol-based. In some cases, initial Calot dissection may be challenging and not at all safe because of dense adhesions. In such cases, retrograde (“fundus-first”) cholecystectomy can be safer. A bipolar approach to surgeons’ position developed in the late 1980s and early 1990s fairly independently on either side of the Atlantic. Thus, the surgeon stands between splayed legs of the patient in the “French” approach, while the surgeon stands on the patient's left in the “American” approach. Exert downward traction on Hartmann's pouch with “bowel grasping” forceps and craniolateral retraction on the fundus with “crocodile” forceps. Actual laparoscopic therapeutic duct exploration is rarely performed in children because the duct is not large enough to enable the safe instrumentation.
