Organic hyperinsulinism and endoscopic surgery.
BACKGROUND
Experience with minimally invasive surgery for organic hyperinsulinism is limited. No criteria for patient selection with special regard to sporadic, hereditary, multiple and malignant tumors have been defined.


METHODS
The estimated success rate of endoscopic surgery was retrospectively calculated by analysing 34 consecutive patients with organic hyperinsulinism operated on by open surgery. A literature search was undertaken to better define indications for endoscopic procedures. Differences in postoperative outcome (morbidity) between endoscopic and open procedures were analysed.


RESULTS
Twenty-eight of 31 patients (90%) with solitary insulinomas and one of three patients with multiple insulinomas were correctly localized preoperatively. Twenty-six enucleations (76%) and eight distal resections (24%) including one endoscopic tail resection were performed. Theoretically only 14 out of 34 patients (41%) would have been suitable for endoscopic surgery (8 enucleations and 6 patients for distal resections which were enucleated using an open approach). Pancreatic fistulas were documented in three patients (9%). Reviewing 34 publications, 49 enucleations, 36 distal resections and 15 conversions to open surgery were performed, showing a higher proportion of distal resections in endoscopic surgery. The spleen was preserved in 88% of cases. Fourteen fistulas occurred after enucleations.


CONCLUSIONS
Only solitary insulinomas localized in the pancreatic tail or superficially in the body or head may be candidates for endoscopic procedures. Patients with multiple insulinomas, MEN-1 syndrome or malignancy should undergo open surgery.
Section Endocrine Surgery, Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria. Klaus.Kaczirek@meduniwien.ac.at
Klaus
K
Kaczirek
Reza
R
Asari
Christian
C
Scheuba
Bruno
B
Niederle
D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006946:Hyperinsulinism / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D007340:Insulinoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome