[Surgery of the endocrine pancreas]

After classification of the endocrine tumours of the pancreas our group of patients during the last 17 years is demonstrated including patients with nesidioblastosis in every case except one with islet cell carcinoma. Beside typical anamnesis and symptoms, diagnosis was confirmed mainly by the glucose/insulin-ratio, the extremely low fasting blood glucose and the increased need of glucose supply for normalisation. Medical therapy with somatostatin and/or diazoxide was not successful in any case for a longer time, although in persistent cases nesidioblastosis became treatable postoperatively with diazoxide. Usually, a so-called 7/8-resection was performed. Typical complications from surgical management of pancreatectomy did not occur none of the children died. As for long-term results, no patient suffered from insulin dependency or insufficiency of the exocrine pancreas; reoperation was also never necessary. The established neurological damage of children who had been operated on late, could not be repaired. Despite the heterogeneous forms of the samples, histochemical investigation established nesidioblastosis in every pancreas specimen. An explanation of the histological findings would be a failure of the B-cell-function as pathogenetic cause of nesidioblastosis.