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Organic hyperinsulinism and endoscopic surgery.

Klaus Kaczirek1, Reza Asari, Christian Scheuba

  • 1Section Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria. Klaus.Kaczirek@meduniwien.ac.at

Wiener Klinische Wochenschrift
|July 1, 2005
PubMed
Summary

Minimally invasive endoscopic surgery for organic hyperinsulinism is limited. Only solitary insulinomas in specific locations are suitable; complex cases require open surgery.

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Minimally Invasive Surgery

Background:

  • Experience with minimally invasive surgery for organic hyperinsulinism is limited.
  • Criteria for patient selection, especially for sporadic, hereditary, multiple, and malignant tumors, are undefined.

Purpose of the Study:

  • To estimate the success rate of endoscopic surgery for organic hyperinsulinism.
  • To define indications for endoscopic procedures by analyzing patient selection and outcomes.
  • To compare postoperative outcomes (morbidity) between endoscopic and open surgical procedures.

Main Methods:

  • Retrospective analysis of 34 consecutive patients with organic hyperinsulinism who underwent open surgery.
  • Literature search to define indications for endoscopic procedures.
  • Analysis of differences in postoperative morbidity between endoscopic and open surgery.

Main Results:

  • Theoretically, only 41% of the studied patients were suitable for endoscopic surgery.
  • Endoscopic surgery showed a higher proportion of distal resections, with spleen preservation in 88% of cases.
  • Pancreatic fistulas occurred in 9% of patients after enucleations.

Conclusions:

  • Solitary insulinomas in the pancreatic tail or superficially in the body/head are potential candidates for endoscopic procedures.
  • Patients with multiple insulinomas, MEN-1 syndrome, or malignancy should be treated with open surgery.