Anatomical features of the gallbladder, its shape and location of the a. cystica in laparoscopic operations for gallbladder pathology in children

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.