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Combined laparoscopic splenectomy and cholecystectomy (CLSC) seems to be the appropriate solution in children that require splenectomy for various pathologies and also have cholelithiasis. This study aimed to evaluate the efficacy, safety and feasibility of CLSC in pediatrics through four ports. Nineteen pediatric patients with hematological disorders underwent CLSC by a 4-port technique, from December 2018 to November 2020. The patients were initially positioned in a right lateral position. The first port was inserted at the umbilicus, the second in the subxiphoid region to the left side of the falciform ligament, the third midway between the umbilical port and the subxiphoid port, and the fourth in the left sub-umbilical region. The operating table was tilted to the right to first perform the splenectomy, after which it was tilted to left to perform the cholecystectomy. For the cholecystectomy, the subxiphoid port was passed through the falciform ligament to the right side. The mean age of the patients was 9.96 years and the mean splenic volume was 327.54 cm3. The mean total operative time was 128.71 min. There was no intra-operative visceral or vascular injury. All procedures were completed without conversions. The mean post-operative hospital stay was 2.28 days. During the follow-up period, no complications were detected. CLSC using four ports is a safe and a feasible procedure, with better cosmetic results, and easy to perform in well-trained hands. PACTR201901796143495.