Minimally Invasive Surgical Treatment of Different Types of Hyperinsulinism

Congenital hyperinsulinism of infancy (CHI) is a rare and genetically heterogeneous disorder that often requires surgical intervention when medical therapy fails. Distinct pathological subtypes of CHI necessitate different surgical strategies. Minimally invasive surgery has increasingly been considered a safe and feasible approach for these patients. This study aimed to evaluate the outcomes of minimally invasive surgery for different CHI subtypes at our center.

We conducted a retrospective single-center review of 110 patients with CHI who underwent minimally invasive surgery between 2011 and 2024.

Pathological subtypes comprised 45 focal, 64 diffuse, and one atypical case. 18F-DOPA PET/CT was performed in 97 patients, demonstrating a diagnostic concordance rate of 94.8%. Conversion to open surgery was required in three patients (two focal and one diffuse) because of intraoperative bleeding, whereas the remaining 107 procedures were completed minimally invasively, including eight robotic-assisted operations (five focal and three diffuse). Among patients with focal CHI, 91.1% achieved cure without postoperative medication. In diffuse disease, near-total pancreatectomy resulted in a higher cure rate than subtotal resection (66.7% vs. 51.2%) but was associated with an increased incidence of postoperative hyperglycemia and common bile duct injury. Two patients required reoperation because of persistent hypoglycemia.

Minimally invasive surgery is a safe and feasible treatment for CHI, providing outcomes comparable to open surgery. Focal CHI is associated with excellent postoperative outcomes and may benefit from earlier surgical intervention. For diffuse CHI, approximately 95% pancreatectomy may achieve satisfactory glycemic control while balancing the risk of postoperative complications.