BSPED2011 Oral Communications Oral Communications 3 (4 abstracts)
Laparoscopic near total pancreatectomy for medically unresponsive diffuse congenital hyperinsulinism
Agostino Pierro 1, , Ori Ron 1, , Shireen Nah 1, , Virpi Smith 1, , Michael Ashworth 1, , Simon Eaton 1, , Paulo Dr Coppi 1, & Khalid Hussain 1,
1Institute of Child Health, University College London, London, UK; 2Great Ormond Street Hospital for Children, London, UK.
Background: Congenital hyperinsulinism (CHI) is cause of severe hyperinsulinaemic hypoglycaemia in the neonatal and infancy periods. Histologically there are three major subgroups, diffuse, focal and atypical. Patients with diffuse CHI who are medically unresponsive will require a near total pancreatectomy. This has traditionally been performed using an open surgical approach.
Aims: To report our experience of laparoscopic near total pancreatectomy for medically unresponsive diffuse CHI.
Methods: We collected data prospectively on all patients who had undergone laparoscopic near total pancreatectomy for CHI in our tertiary referral Centre between the periods 2004–2009.
Results: A total of 22 consecutive children underwent laparoscopic near-total pancreatectomy for medically unresponsive CHI. The median age at the time of surgery was 3 months (1–120) and median weight was 5.5 kg (4.4–33.4 kg). Seven patients (32%) were converted to open, mostly because of bleeding. There were three common bile duct injuries and no deaths from the laparoscopic procedure. Full enteral feeds were achieved at a median age of 9 days (range 4–17) after the pancreatectomy. Postoperative morphine requirement was limited to the first post-operative day. Octreotide (in decreasing doses) was used in six patients following the laparoscopic near total pancreatectomy. At a median follow up of 46 months (6–86), no patient has required further pancreatic resection. Two children are diabetic and two require pancreatic enzyme replacement.
Conclusion: Laparoscopic near-total pancreatectomy is a novel minimally invasive procedure which is feasible and safe and is associated with prompt post-operative recovery, low complication rate and good outcome. In Centre’s with advanced laparoscopic expertise laparoscopic near-total pancreatectomy should be the preferred technique for infants with diffuse CHI.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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