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Treatment of hypoglycemia in infants and children. Surgical considerations
Insights
Surgical resection of the pancreas effectively treated persistent hypoglycemia in pediatric patients with adenomatous disease. However, diffuse pancreatic lesions often necessitated ongoing medical management and aggressive treatment is crucial to prevent neurological damage.
Area of Science:
- Pediatric Surgery
- Endocrinology
- Gastroenterology
Background:
- Persistent hypoglycemia in pediatric patients poses a significant challenge, often requiring surgical intervention.
- Current management strategies for intractable hypoglycemia include surgical approaches, but their efficacy varies with underlying pathology.
Purpose of the Study:
- To evaluate the outcomes of a standardized surgical approach for pediatric patients with persistent hypoglycemia.
- To assess the effectiveness of subtotal distal pancreatectomy and associated procedures in controlling hypoglycemia and preventing neurological sequelae.
Main Methods:
- A retrospective review of 11 pediatric patients undergoing pancreatic resection over 14 years.
- Standardized surgical approach included subtotal distal pancreatectomy, liver biopsy, and removal of adenomatous tissue.
- Visceral angiography was reserved for patients requiring re-exploration.
Main Results:
- Surgical resection was curative for patients with adenomatous pancreatic disease.
- Patients with diffuse pancreatic lesions typically required continued pharmacologic therapy postoperatively.
- Two patients underwent total pancreatectomy due to persistent intractable disease.
Conclusions:
- A standardized surgical approach, including subtotal distal pancreatectomy, is effective for managing pediatric persistent hypoglycemia due to adenomatous disease.
- Aggressive management is essential to minimize permanent neurological damage, as seizure disorders and cognitive impairments often persist despite glycemic control.
Abstract:
Pancreatic resection was required in 11 pediatric patients over a 14 year period for control of persistent hypoglycemia. A standard surgical approach based on pathologic considerations was utilized. A subtotal distal pancreatectomy, liver biopsy, and removal of additional adenomatous tissue when found was performed in each patient. This approach precluded the need for routine preoperative visceral angiography, which is currently reserved for patients who require a second exploration. Surgery was curative in patients with adenomatous disease, although patients with diffuse pancreatic lesions usually required continued pharmacologic therapy postoperatively. Two patients thus far have had a total pancreatectomy performed at a second laparatomy due to persistent intractable disease. Seizure disorders, mental retardation, and behavioral problems frequently were unresponsive to improved control of hypoglycemia. An aggressive approach to management of this disorder is required if permanent neurologic damage is to be minimized.