Laparoscopic subtotal pancreatectomy for infants with persistant hyperinsalinemic hypoglycemia

Abstract

Objective To explore the resection range, laparoscopic technique and management of surgical complications of subtotal pancreatectomy for 16 patients with persistent hyperinsulinemic hypoglycemia of infancy(PHHI). Methods A total of 16 PHHI infants underwent subtotal pancreatectomy from March 2011 to December 2014. And retrospective analyses were performed for the clinical data, treatment procedures and operative outcomes. There were 9 boys and 7 girls with an age range of 17 days to 6 months. The fasting levels of blood glucose and insulin were 0.5-5.1 mmol/L and 4.1-50.1 mU/L respectively. All required the therapy of glucagon and the maintenance of hypertonic glucose. There was a unresponsiveness to diazoxide treatment. No obvious abnormality was identified on computed tomography(CT) or magnetic resonance imaging(MRI). Among 3 patients with gene detection, 2 had a gene mutation of KATP pathway(ABCC8 & KCNJ11). Results The three-trocar laparoscopy was employed with a resection rate of 95% and no operative mortality. One patient with an injury of splenetic vein was injured and occluded intraoperatively. And splenomegaly occurred after 6 months. Two patients underwent hepaticojejunostomy with Roux-Y anastomosis due to biliary obstruction. During a postoperative follow-up period of 2-6 months, the level of fasting blood glucose was 2.2-12 mmol/L. Two cases of hypoglycemia required glucagon. And the fasting level of glucose was low and back to normal after eating in 3 cases. Ten patients maintained the fasting blood glucose basically within a normal range. One case with suspected focal lesion of pancreas underwent focal resection of pancreatic tail and relapsed after 2 weeks. Conclusions The surgical localization of PHHI should be determined according to MRI, ultrasound, CT, gene detection and intraoperative pathology. Diffuse type is a major variant of infantile PHHI and 95% pancreatectomy is proper. Laparoscopic subtotal pancreatectomy is both safe and effective in the treatment of PHHI. Hemorrhage and biliary obstruction closely related with incision suturing are common after surgery. Suturing the incision of pancreatic head is unnecessary during applying ultrasonic scalpel. Key words: Hypoglycemia; Laparoscopy; Pancreatectomy