Laparoscopic near-total pancreatectomy for persistent hyperinsulinemic hypoglycemia in infants and children

Abstract

Purpose

There are few reports regarding laparoscopic near-total pancreatectomy (LNTP) for hyperinsulinemic hypoglycemia of infancy (PHHI) present. Our experience with 5 cases is presented.

Methods

The records of 5 children (3 boys, 3 infants) who underwent LNTP for diffuse PHHI between January 2017 and September 2019 were reviewed. Diagnosis of diffuse PHHI was established by clinical, biochemical, radiologic and genetic testing. All children initially received medical management with diazoxide and otreotide. The time from diagnosis to surgery was 2 weeks–42 months. The indications for surgery were failed medical management (early failure in 2, late failure in 1) and/or complications of medical management in 3). All children underwent laparoscopic 95% pancreatectomy by a single surgeon.

Results

In all five children (age 1–42 months, median 2 months; weight 3.5–16 kg median 4.8 kg), LNTP were successfully completed by laparoscopy (operating time 80–180 min, median 105 min). There were no intra/post-operative complications. At a mean follow-up of 30.8 months (24–48), all children are euglycemic without any medication, and thriving well. None has developed diabetes or malabsorption. The cosmetic results have been excellent.

Conclusions

In centers with advanced laparoscopic expertise, LNTP may be the preferred technique of surgery in children with diffuse PHHI requiring surgery. LNTP is feasible, safe, associated with good post-operative recovery, good outcome and excellent cosmetic result. Long-term follow-up is essential due to the possibility of developing diabetes.