HYDERABAD PERFORMS ITS FIRST LAPAROSOCPIC CHOLECYSTECTOMY IN 10 MONTH OLD CHILD

A child 10 months old was diagnosed with cholelithiasis.The presentation was recurrent abdominal colic.The other hematological and biochemical parameters of the child were normal. The child was investigated for any hematological disorders like sickle cell disorder. The decision as taken for the laparoscopic cholecystectomy. Anaesthetic consideration: The baby was monitored closely for end tidal CO2 ,Peak Inspiratory Pressure(PIP), pulse oximetry and the blood pressure.To prevent any barotrauma the intra-abdominal pressure was kept between 7-12 mm Hg.As the children are prone for hypercarbia due to quick absorption of Co2 ; the minute ventilation was increased to keep the baby on hypocarbia side.( ETCo2 was kept between 28-32 mm Hg and Pa Co2 between 31-35 mmhg). The baby was catheterized before the start of the procedure and also the nasogastric tube was kept.The prophylactic antibiotic cefotaxim and normetrogyl. Surgical consideration: The surgery especially the laparoscopic surgeries in infants should be done in optimum time as the delay can compound the hypercarbia problem. The four port approach was adopted.The infraumbilical smile incision was taken and open port insertion was done.A 10 mm port was inserted.Rest 3 ports of 5 mm were inserted as depicted in the picture.

The port insertion was done in anti-Trendelenburg position.The Calots triangle was carefully dissected and the usual cholecystectomy was carried out. Background:The laparoscopuic cholecystectomy as such is very rare in infants.With the abundant usage of abdominal ultrasound in colics such cases are bound to increase in future. The physiological and anatomical considerations in infants make the laparoscopic cholecystectomy a special case.Extreme precautions and care should be excercised during and after the surgery.