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Laparoscopic pancreatectomy for persistent hyperinsulinemic hypoglycemia of infancy
M L Blakely1, T E Lobe, J Cohen
1Section of Pediatric Surgery, University of Tennessee, 777 Washington Avenue, Ste. P220, Memphis, TN 38105, USA.
Insights
Laparoscopic pancreatectomy is a safe and effective initial surgical approach for infants with persistent hyperinsulinemic hypoglycemia of infancy (PHHI). This minimally invasive technique offers excellent pancreatic exposure and avoids prolonged operative time or risks.
Area of Science:
- Pediatric surgery
- Minimally invasive surgery
- Endocrinology
Background:
- Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is a rare condition requiring medical and surgical management.
- A 4-week-old infant with PHHI underwent a laparoscopic pancreatectomy to assess feasibility.
- Preoperative management included diazoxide and glucagon to stabilize blood glucose.
Observation:
- Laparoscopic pancreatectomy was performed using specialized techniques for pancreatic and lesser sac exposure.
- The procedure involved splenic vein preservation and minimal blood loss.
- Surgery duration was 75 minutes.
Findings:
- The infant tolerated a regular diet post-surgery with no narcotic requirement.
- Postoperative glucose levels decreased, necessitating medical support.
- A subsequent open near-total pancreatectomy was performed successfully on postoperative day 7.
Implications:
- Laparoscopic pancreatectomy is a safe and feasible option for newborns with PHHI.
- The described technique provides optimal surgical field visualization.
- This approach is ideal for PHHI patients who may require reoperation.
Background:
A 4-week-old male infant (4.9 kg) with persistent hyperinsulinemic hypoglycemia of infancy (PHHI) underwent a laparoscopic pancreatectomy to evaluate its feasibility. Preoperative medications included diazoxide and glucagon to maintain adequate blood glucose levels.
Methods:
Laparoscopic pancreatectomy was performed using a 5-mm cannula at the umbilicus, external fixation, transcutaneous suture-assisted gastric retraction to expose the lesser sac, and three additional 3.5-mm cannula sites. The pancreas was resected from the splenic hilum to the mesenteric vessels. The splenic vein was dissected from the under surface of the pancreas using electrocautery, and the spleen was easily preserved. Surgery time was 75 min, and minimal blood loss occurred.
Results:
The child required no narcotic medication and tolerated a regular diet immediately after surgery. Serum glucose levels did decrease postoperatively, and the child required diazoxide, dextrose infusion, glucagon, and octreotide. On postoperative day 7, the child underwent an open near-total pancreatectomy, after which he remained asymptomatic. Essentially no scarring was found in the lesser sac, and the remaining pancreatic remnant was resected without difficulty.
Conclusions:
Laparoscopic pancreatectomy can be performed safely, even in a newborn patient, without prolonged operative time or unnecessary risk. The technique using external fixation and transcutaneous suture-assisted gastric retraction provides excellent exposure to the pancreas and lesser sac. In patients with PHHI, in whom reoperative additional pancreatectomy is very likely, this technique is the ideal initial surgical approach.