Laparoscopic Pancreatectomy for Persistent Hyperinsulinemic Hypoglycemia of Infancy - Case Series.

CONTEXT: Hypoglycemia in neonates can be attributed to Persistent Hyperinsulinemic Hypoglycemia of Infancy (PHHI). Even though initial management involves the use of medical agents, requirement of surgery is seen in a large number of cases, particularly in those who are nonresponsive. Open pancreatectomy has been the gold standard in the management of PHHI, but there has been a recent inclination toward the use of minimally invasive procedures, namely laparoscopic pancreatectomy to achieve similar results with lesser morbidity. AIMS: The aim of this study is to describe the presentation, key technical points, and outcomes of laparoscopic pancreatectomy in the management of PHHI. MATERIALS AND METHODS: A retrospective study which was conducted between January 2019 and September 2024 which included 7 children who were diagnosed to have PHHI. RESULTS: All seven patients who were operated were infants with an average age of 4 months (range 1-5 months), with the youngest patient being one and half months of age. All of them underwent a laparoscopic pancreatectomy with the average duration of the procedure being 60 min and with very minimal blood loss. A distal pancreatectomy was performed in one infant while a near total pancreatectomy was performed in the other six infants. Euglycemia was achieved in six cases and they are on regular follow-up, with the longest duration of follow-up being 4 years and 3 months. The average duration of follow-up has been 3 years and 6 months, ranging from 1 month to 4 years and 3 months. One child had postoperative requirement of octreotide for 2 weeks after which it was tapered and stopped. One child had persistent hypoglycemic episodes and required a completion pancreatectomy 6 months after the initial surgery. No intraoperative or postoperative complications were noted. CONCLUSION: Laparoscopic pancreatectomy is an excellent tool in the armamentarium of surgeons looking for an effective surgical modality to treat PHHI with minimal morbidity.