In the past 15 years ten infants had subtotal pancreatectomy for idiopathic hypoglycemia of infancy. In five of these (50%), initial surgery failed to control hypoglycemia which recurred in 1 day to 2 weeks. When reinstitution of medical therapy did not satisfactorily control the blood sugar, total pancreatectomy was performed by excision of the residual pancreatic tissue. There were no postoperative surgical complications and hypoglycemia was eliminated in all. “Total” pancreatectomy was well tolerated by these growing infants. Insulin is necessary in three children and four require oral pancreatic enzymes for adequate intestinal absorption. The high failure rate of a standard two-thirds pancreatectomy and the safety of a more extensive operation suggest that a pancreatic resection of 80 to 90% is warranted as an initial surgical approach. “Total” pancreatectomy should still be reserved for the surgical failures.