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[Multidisciplinary approach to surgical disorders of the pancreas in children]
Insights
Pediatric pancreatic surgery requires a multidisciplinary team approach for optimal outcomes. This study highlights the importance of collaboration in diagnosing and treating rare pancreatic conditions in children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Surgical Oncology
Background:
- Surgical pancreatic diseases in children are rare but can lead to significant morbidity and mortality.
- A multidisciplinary approach is crucial for accurate diagnosis, surgical planning, and postoperative care.
Purpose of the Study:
- To review the diagnostic and surgical management of pancreatic lesions in children.
- To analyze surgical procedures, postoperative complications, and long-term outcomes in pediatric patients.
Main Methods:
- Retrospective analysis of 89 children treated for pancreatic lesions between 1991 and 2016.
- Focus on diagnostics, surgical procedures, complications, and long-term results.
Main Results:
- Common indications included trauma (34), solid pseudopapillary tumors (23), and hyperinsulinism (8).
- Frequent procedures were distal pancreatectomy (35) and duodenum-preserving pancreatic head resection (23).
- Mortality occurred in 3 patients, primarily due to polytrauma or pancreatic cancer.
Conclusions:
- Pediatric pancreatic surgery is uncommon, with limited individual and institutional experience.
- Close collaboration among pediatric surgeons, gastroenterologists, radiologists, anesthesiologists, intensivists, pathologists, and ERCP specialists is essential for successful outcomes.
- Effective management of pediatric pancreatic diseases relies on a coordinated, multidisciplinary effort.
Introduction:
Surgical diseases of the pancreas in children are not common and may be associated with significant morbidity and potential mortality. A multidisciplinary approach is essential for correct diagnosis, surgical strategy and postoperative as well as follow-up care.
Method:
Retrospective analysis of patients operated on due to a pathological lesion of the pancreas focused on diagnostics, operating procedures, postoperative complications, and long-term results. Between 1991 and 2016, eighty-nine children were treated in our department for a pathologic lesion of the pancreas. 39 of them were boys and 50 were girls.
Results:
Mean age of the patients was 9.3 years (1 month-18.4 years). Patients were followed from the operation to the age of 19, after which they were referred for follow-up to adult specialists. The indications for surgery were trauma in 34 children, solid pseudopapillary tumor in 23 children, biopsy in 10, hyperinsulinism in 8, chronic pancreatitis in 4, pancreatic cyst in 3, insulinoma in 3, carcinoma in 2, and serous cystadenoma and pancreas divisum in one patient. The most frequent procedures performed on the pancreas were distal pancreatectomy in 35 cases, the duodenum-preserving pancreatic head resection in 23 cases, pseudocystogastroanastomosis in 11 cases, 9095% pancreatic resection in 5 cases, Whipple operation in two cases, Puestow procedure in one case, tumor enucleation in one case, and tumor biopsy for cancer in one case. In 5 patients after major pancreatic injury, ERCP and papillotomy with insertion of a stent into the pancreatic duct was performed. 3 patients died, one after a polytrauma with severe pancreatic injury and two patients with pancreatic cancer.
Conclusion:
Pancreatic surgery in children is not a common operation, and individual as well as institutional experience remains limited. After more than 20 years of experience with pancreatic surgery, we believe that close cooperation with surgeons, pediatric gastroenterologists, radiologists, anesthesiologists, intensivist, pathologists and ERCP specialists is necessary for successful diagnosis and treatment of pancreatic disease in children.Key words: pancreas pancreatic surgery in children duodenum preserving head resection of the pancreas.
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