[Minimal-invasive operative treatment of organic hyperinsulinism]

Insulinomas are small, solitary and benign endocrine pancreatic tumours, causing organic hyperinsulinism by autonomous insulin-secretion. Episodes of severe hypoglycemia and progressive obesity are the most frequent clinical signs. Surgical resection of the tumours is always indicated for cure. Because the tumours are small and surgical trauma for adequate exposure of the pancreas is considerable, laparoscopic techniques to approach these tumours are attractive. On the occasion of two cases, this report describes the laparoscopic treatment of these rare tumors.

Two male patients (15 years of age and 50 years of age) were admitted for seizures and symptoms of hypoglycaemia.

During fasting tests, both were diagnosed organic hyperinsulinism, with a blood glucose level of 28 mg/dl, insulin of 15.9 mU/ml and a c-peptide of 1.7 microg/l for an insulinogenic index of 0.57 determined in the young man. Similar values were obtained in the older man. Conventional imaging procedures were non diagnostic whereas endoscopic ultrasound of the pancreas revealed a 8 x 13 and 10 x 9 mm lesion in the pancreas.

Laparoscopic resection of the tumor was attempted and accomplished in both patients. The young man underwent laparoscopic enucleation of the tumor, while the 50 year old man underwent left sided laparoscopic resection of the pancreas because the tumor was adjacent to the pancreatic duct. Postoperative course was uneventful in both cases.

It is to be expected, that this approach will receive increasing attention in the near future.