Laparoscopic Pancreatectomy for Persistent Hyperinsulinemic Hypoglycemia of Infancy - Case Series

Hypoglycemia in neonates can be attributed to Persistent Hyperinsulinemic Hypoglycemia of Infancy (PHHI). Even though initial management involves the use of medical agents, requirement of surgery is seen in a large number of cases, particularly in those who are nonresponsive. Open pancreatectomy has been the gold standard in the management of PHHI, but there has been a recent inclination toward the use of minimally invasive procedures, namely laparoscopic pancreatectomy to achieve similar results with lesser morbidity.

The aim of this study is to describe the presentation, key technical points, and outcomes of laparoscopic pancreatectomy in the management of PHHI.

A retrospective study which was conducted between January 2019 and September 2024 which included 7 children who were diagnosed to have PHHI.

All seven patients who were operated were infants with an average age of 4 months (range 1-5 months), with the youngest patient being one and half months of age. All of them underwent a laparoscopic pancreatectomy with the average duration of the procedure being 60 min and with very minimal blood loss. A distal pancreatectomy was performed in one infant while a near total pancreatectomy was performed in the other six infants. Euglycemia was achieved in six cases and they are on regular follow-up, with the longest duration of follow-up being 4 years and 3 months. The average duration of follow-up has been 3 years and 6 months, ranging from 1 month to 4 years and 3 months. One child had postoperative requirement of octreotide for 2 weeks after which it was tapered and stopped. One child had persistent hypoglycemic episodes and required a completion pancreatectomy 6 months after the initial surgery. No intraoperative or postoperative complications were noted.

Laparoscopic pancreatectomy is an excellent tool in the armamentarium of surgeons looking for an effective surgical modality to treat PHHI with minimal morbidity.