Efficacy of single-incision laparoscopic 90% pancreatectomy for persistent hyperinsulinemic hypoglycemia in infants

Abstract

Objective To explore the efficacy and outcomes of single-incision laparoscopic 90% pancreatectomy for persistent hyperinsulinemic hypoglycemia of infancy (PHHI). Methods From July 2011 to February 2015, single incision laparoscopic 90% pancreatectomy was performed in three PHHI children. All of them received 18F-DOPA PET/CT preoperatively and diffuse physiologic 18F-DOPA activity was evident in entire pancreas. And the postoperative levels of blood glucose and insulin were recorded. Results Single-incision laparoscopic partial pancreatectomy was successfully performed in all cases. None of them required a conversion into a conventional multi-incision or open procedure. The operative duration was 120 to 230 min. Blood loss was minimal and there was no necessity for blood transfusion. The duration of postoperative abdominal drainage was 4 to 5 days. And the postoperative hospitalization length was 6 days. A definite diagnosis of diffuse nesidioblastosis was established histopathologically. The postoperative level of fasting blood glucose was higher than that of pre-operation (4.38-8.9 vs. 0.54-1.8 mmol/L). And the postoperative level of fasting insulin was lower than that of pre-operation (2.4-5.5 vs. 14-33.3 μU/ml). During a follow-up period of 4 to 46 months, the levels of blood glucose and insulin were restored in three children. There was no postoperative recurrence of hypoglycemia. Conclusions Single incision laparoscopic 90% pancreatectomy is both safe and effective for PHHI children. Key words: Laparoscopes; Hyperinsulinism; Child; Hypoglycemia