100 Laparoscopic pancreatic surgery in children with congenital hyperinsulinism is safe and effective

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Abstract

Aim

To analyse the initial experience for laparoscopic pancreatic surgery in children in congenital hyperinsulinism (CHI).

Methods

A retrospective 5 year review (2013–2017) of all pancreatic surgery for CHI in children performed in one surgical centre by one surgeon was undertaken. Data was collated on patient demographics including mode of surgery: open or laparoscopic. Pre-operative 18 F-DOPA PET scan results were used to differentiate between diffuse and focal CHI. The type and site of the CHI lesion was then correlated with the completion rate of the laparoscopic approach.

Results

There were a total of 10 patients and 14 episodes of surgery. All patients had a confirmed diagnosis of CHI. The median age at surgery is 7 months (range 2–22). A laparoscopic approach was completed in 85% (11/13) of operations. One child had a planned open operation. Four patients (40%) had more than one operation for CHI. 80% (4/5) of those with diffuse CHI had laparoscopic operations. One required conversion to open as the pneumoperitoneum was not well tolerated in a 2 month old infant. 100% (5/5) of patients with focal CHI in the tail of the pancreas had completed laparoscopic operations. 50% (2/4) had laparoscopic surgery for focal head of pancreas CHI lesion.

Conclusion

A planned laparoscopic approach is possible in the vast majority of cases of surgery for CHI. The completion laparoscopic rate is high (85%). Possible risk factors for open surgery including young age and focal lesion in the head of the pancreas. The rate of open surgical approach in view of the PET scan findings is important when counselling families pre-operatively.

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