Organic hyperinsulinism and endoscopic surgery View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2005-01-01

AUTHORS

Klaus Kaczirek, Reza Asari, Christian Scheuba, Bruno Niederle

ABSTRACT

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. More... »

PAGES

19-25

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00508-004-0287-6

DOI

http://dx.doi.org/10.1007/s00508-004-0287-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1040733162

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/15986586


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