Organic hyperinsulinism: radiological diagnostics and surgical treatment.
OBJECTIVE
To optimize the diagnosis and surgical treatment of insulinoma and nesidioblastosis.


METHODS
42 patients with organic hyperinsulinism (OH) were operated. There were 39 cases of insulinoma including 2 patients with insulinoma combined with nesidioblastosis and 3 cases of nesidioblastosis alone. Preoperative ray imaging consisted of percutaneous, endoscopic and intraoperative sonography, contrast-enhanced computed tomography, magnetic resonance imaging (MRI). Functional test included arterial-stimulated blood sampling (ASBS). Laparotomy and robot-assisted techniques were used in 22 and 20 patients.


RESULTS
Sensitivity was 62.0%, 76.9%, 83.3%, 87.5%, 94.8% and 100% in percutaneous sonography, CT, endoscopic sonography, MRI, intraoperative sonography and ASBS respectively. Postoperative complications were observed in 14 and 6 patients after conventional and robot-assisted surgery. 2 patients died. Overall mortality was 4.8%. None patient had recurrent hypoglycemic conditions in long-term postoperative period (mean follow-up 18.7 months).


CONCLUSIONS
Comprehensive survey allowed to define the cause of OH. Minimally invasive organ-sparing surgery has satisfactory immediate and remote results in these patients.
A.V. Vishnevsky Institute of Surgery, Moscow, Russia.
A G
AG
Krieger
A.V. Vishnevsky Institute of Surgery, Moscow, Russia.
A V
AV
Smirnov
A.V. Vishnevsky Institute of Surgery, Moscow, Russia.
S V
SV
Berelavichus
A.V. Vishnevsky Institute of Surgery, Moscow, Russia.
D S
DS
Gorin
A.V. Vishnevsky Institute of Surgery, Moscow, Russia.
A R
AR
Kaldarov
A.V. Vishnevsky Institute of Surgery, Moscow, Russia.
N A
NA
Karel'skaya
A.V. Vishnevsky Institute of Surgery, Moscow, Russia.
N N
NN
Vetsheva
A.V. Vishnevsky Institute of Surgery, Moscow, Russia.
D V
DV
Kalinin
A.V. Vishnevsky Institute of Surgery, Moscow, Russia.
A N
AN
Lebedeva
A.V. Vishnevsky Institute of Surgery, Moscow, Russia.
R S
RS
Dugarova
D000328:Adult; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D007003:Hypoglycemia / Q000175:diagnosis / Q000209:etiology; D007340:Insulinoma / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009031:Moscow; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome