Paediatric Surgery (Ukraine). 2025. 1(86): 15-21. doi: 10.15574/PS.2025.1(86).1521
Bodnar O. B.¹, Khashchchuk V. S.², Vatamanesku L. I.¹, Randiuk R. Yu.¹, Bodnar A. O.^1
1Bukovinian State Medical University, Chernivtsy, Ukraine
²MME «Children’s clinical city hospital», Chernivtsy, Ukraine

For citation: Bodnar OB, Khashchchuk VS, Vatamanesku LI, Randiuk RYu, Bodnar AO. (2025). Anatomical features of the gallbladder, its shape and location of the a. cystica in laparoscopic operations for gallbladder pathology in children. Paediatric Surgery (Ukraine). 1(86): 15-21. doi: 10.15574/PS.2025.1(86).1521.
Article received: Oct 16, 2024. Accepted for publication: Mar 18, 2025.

The incidence of gallbladder (GB) diseases requiring laparoscopic cholecystectomy has significantly increased in recent years. The development of pathology in many cases is associated with the anatomical features of the GB and the cystic artery.
Aim – to investigate the anatomical features of the gallbladder and cystic artery during laparoscopic surgery for gallbladder diseases in children in order to identify predictors of cholelithiasis.
Materials and methods. During the period from 2022 to 2024, 16 children aged 8 to 17 years were operated on. We studied the clinical picture, data of additional diagnostics methods, course of surgical intervention and anatomical features, results of histological examination. To establish the correlation between the shape of the gallbladder, anatomical variations in the course of the cystic artery, and the development of gallbladder pathology.
Results. When laparoscopic cholecystectomy was performed in children, various abnormalities of the gallbladder, shape, and cystic artery were observed. Considering the anatomical abnormalities of GB in children operated on for its pathology: only 31.25% of children had no abnormalities, intrahepatic GB was in 12.5% of cases, GB according to the "hourglass" type – in 15%, mobile GB with mesentery – 25%, doubling of GB – 6.25%. Thus, 68.75% of children had anatomical prerequisites for the occurrence of his diseases. The pear-shaped form (25.0%) and the form of GB with constrictions (25.0%) were most common. There was no form in 12.5% of cases. Club-shaped and egg-shaped forms were in 18.75% and 18.75%, respectively. The classic variant of the artery was observed in 50%. A. cystica passed high in the gate of the liver in 25.0%, on the side of the GB lodge – 6.25%, crossed the common bile duct in 6.25%, doubling of the hepatic artery – 12.5%. When performing a histological examination, intramural microlithiasis was present in 56.25%, intestinal metaplasia in only 6.25% of cases.
Conclusions. Anatomical abnormalities of the gastrointestinal tract in calculous cholecystitis and polyposis are observed in 68.75% of children. Form of GM is a preresquisite of the occurrence of disease of the GB. (constrictions of the GB contributes to the occurrence of calculus to a greater degree than other forms). Non-classical variant of location a. cystica (50.0%) contributes to the disruption of blood supply to the wall and the formation of stones or the development of polyps. Intramural microlithiasis in 56.25% indicates non-functioning of the gastrointestinal tract and the need for its removal.
The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the work. Informed consent of the patients was obtained for the research.
The authors declare no conflict of interest.
Keywords: gallbladder, children, calculous cholecystitis, polyposis, anatomical features.

REFERENCES

1. Aboelela A, Abouheba M, Khairi A, Kotb M. (2022, Aug 29). Evaluation of the safety of using harmonic scalpel during laparoscopic cholecystectomy in children: A preliminary report. Front Pediatr. 10: 998106. https://doi.org/10.3389/fped.2022.998106; PMid:36105859 PMCid:PMC9464866

2. Al-Tarakji M, AlFkey R, Aljohary H, Sameer M, Muhammad Ali S. (2021, Nov 25). Successful Surgical Management of Unusual Gallbladder Anatomy Through Laparoscopic Cholecystectomy of Ectopic Gallbladder. Cureus. 13(11): e19884. https://doi.org/10.7759/cureus.19884; PMid:34966602 PMCid:PMC8710038

3. Anderson K, Roland AL, Miller MP, Foretia DA. (2022, Sep). Beware of the shrunken gallbladder – Case report of intraoperatively diagnosed gallbladder agenesis. Int J Surg Case Rep. 98: 107588. Epub 2022 Aug 31. https://doi.org/10.1016/j.ijscr.2022.107588; PMid:36058154 PMCid:PMC9482971

4. Debaibi M, Sghair A, Sridi A, Chouchen A. (2022, Apr 4). Septate gallbladder: A rare congenital anomaly. Clin Case Rep. 10(4): e05666. https://doi.org/10.1002/ccr3.5666; PMid:35414909 PMCid:PMC8979156

5. Destro F, Pierucci UM, Durante E, Caruso AM, Girgenti V, Canonica CPM et al. (2023, Oct 31). Laparoscopic Cholecystectomy in Children: The Experience of Two Centers Focusing on Indications and Timing in the Era of "New Technologies". Children (Basel). 10(11): 1771. https://doi.org/10.3390/children10111771; PMid:38002862 PMCid:PMC10670818

6. Di Pasquo E, Kuleva M, Rousseau A, Vitucci A, Sonigo P, Chardot C et al. (2019, Nov). Outcome of non-visualization of fetal gallbladder on second-trimester ultrasound: cohort study and systematic review of literature. Ultrasound Obstet Gynecol. 54(5): 582-588. https://doi.org/10.1002/uog.20252; PMid:30809885

7. Handra-Luca A, Ben Romdhane HM, Hong SM. (2020, Aug). Luschka Ducts of the Gallbladder in Adults: Case Series Report and Review of the Medical Literature. Int J Surg Pathol. 28(5): 482-489. Epub 2020 Jan 26. https://doi.org/10.1177/1066896920901334; PMid:31983263

8. Jiménez GJ, Jiménez AP, Betancourth AJ, Santiago MS, San Vicente VB, Gaspar PM et al. (2023, Oct 1). Urgent laparoscopic cholecystectomy as a result of acute calculous cholecystitis in Pediatrics. Cir Pediatr. 36(4): 186-190. https://doi.org/10.54847/cp.2023.04.15; PMid:37818901

9. Lascano D, Lai R, Stringel G, Stewart FD. (2021, Oct-Dec). Weekend Admissions Associated with Increased Length of Stay for Children Undergoing Cholecystectomy. JSLS. 25(4): e2021.00047. https://doi.org/10.4293/JSLS.2021.00047; PMid:34949908 PMCid:PMC8678762

10. Mahat S, Bhattarai V, Kandel D, Mehta K, Singh S. (2022, Sep 29). Duplication of the gallbladder: Case report of a rare biliary malformation. Radiol Case Rep. 17(12): 4613-4616. https://doi.org/10.1016/j.radcr.2022.08.091; PMid:36193279 PMCid:PMC9525815

11. Metman MJH, Olthof PB, van der Wal JBC, van Gulik TM, Roos D, Dekker JWT. (2020, Apr). Clinical relevance of gallbladder polyps; is cholecystectomy always necessary? HPB (Oxford). 22(4): 506-510. Epub 2019 Aug 31. https://doi.org/10.1016/j.hpb.2019.08.006; PMid:31481314

12. Oyachi N, Numano F, Koizumi K, Takano A, Shibusawa H. (2022, Jan 21). Multiseptate gallbladder coexisting with pancreaticobiliary maljunction treated by laparoscopic cholecystectomy: report of a pediatric case. Surg Case Rep. 8(1): 16. https://doi.org/10.1186/s40792-022-01370-4; PMid:35061125 PMCid:PMC8782956

13. Pelizzo G, Bussani R, De Silvestri A, Di Mitri M, Rosone G, Amoroso S et al. (2020, May 8). Laparoscopic Cholecystectomy for Symptomatic Cholecystic Disease in Children: Defining Surgical Timing. Front Pediatr. 8: 203. https://doi.org/10.3389/fped.2020.00203; PMid:32457858 PMCid:PMC7225274

14. Schachner A. (1916, Oct). Anomalies of the gall-bladder and bile-passages: with the report of a double gall-bladder and a floating gall-bladder. Ann Surg. 64(4): 419-433. https://doi.org/10.1097/00000658-191610000-00007; PMid:17863610 PMCid:PMC1426349

15. Singh JP. (2021, Feb 11). Duplication of the Gallbladder as an Operative Surprise: A Case Report with Review of the Literature. Case Rep Surg. 2021: 6668302. https://doi.org/10.1155/2021/6668302; PMid:33628570 PMCid:PMC7895607

16. Sinha A, Mattson A, Njere I, Sinha CK. (2024, Mar 6). Comparison of laparoscopic cholecystectomy in children at paediatric centres and adult centres: a systematic review and meta-analysis. Ann R Coll Surg Engl. Epub ahead of print. https://doi.org/10.1308/rcsann.2023.0041; PMid:38445605 PMCid:PMC11785448

17. Uemura S, Maeda H, Obatake M, Namikawa T, Kitagawa H, Fujieda Y et al. (2021, Dec 22). Laparoscopic cholecystectomy for gallbladder torsion in a 3-year-old child. Acute Med Surg. 8(1): e722. https://doi.org/10.1002/ams2.722; PMid:34987833 PMCid:PMC8693826

18. Winters M, Clar DT, Van Fossen K. (2023, Jun). Intraoperative Diagnosis of Gallbladder Agenesis. Am Surg. 89(6): 2844-2846. Epub 2021 Dec 7. https://doi.org/10.1177/00031348211060440; PMid:34873961