[Is preoperative localization of insulinomas necessary?]

To appreciate the impact of preoperative localization in surgical treatment of insulinomas.

From 1986 to 2001, 29 patients were surgically treated for suspected insulinoma. Preoperative imaging assessment was performed in 26 patients: ultrasonography (n = 21), computed tomography (n = 23), endoscopic ultrasonography (n = 13), intraoperative ultrasonography (n = 22) (2 of them under laparoscopic approach).

The sensibility of the localization procedures was as follows: ultrasonography = 9.6%, computed tomography = 39%, endoscopic ultrasonography = 92.3%, surgical exploration 79.3%, intraoperative ultrasonography 86.3%. The sensibility of intraoperative palpation associated which intraoperative ultrasonography was 100%. Surgical procedures included: 11 enucleations, 10 segmental resections of the tail, 1 left pancreatectomy, 3 median pancreatectomies, 4 subtotal pancreatectomies. There was no postoperative mortality and postoperative morbidity rate was 17%, including 4 pancreatic leakages. Histological examination found solitary tumor in 22 patients (1 of them was a malignant tumor), multiple tumors (MEN 1) in 4 patients and factitious hypoglycemia in 3 patients. All the insulinomas were resected.

Intraoperative evaluation of the pancreas with intraoperative ultrasonography was associated which a right localization in 100% of insulinomas. The place for preoperative imaging seems to be limited. A laparoscopic approach in sporadic insulinomas could modify this attitude.