The role of “total” pancreatectomy in the treatment of unremitting hypoglycemia of infancy

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Abstract

In the past 15 years ten infants had subtotal pancreatectomy for idiopathic hypoglycemia of infancy. In five of these (50%), initial surgery failed to control hypoglycemia which recurred in 1 day to 2 weeks. When reinstitution of medical therapy did not satisfactorily control the blood sugar, total pancreatectomy was performed by excision of the residual pancreatic tissue. There were no postoperative surgical complications and hypoglycemia was eliminated in all. “Total” pancreatectomy was well tolerated by these growing infants. Insulin is necessary in three children and four require oral pancreatic enzymes for adequate intestinal absorption.

The high failure rate of a standard two-thirds pancreatectomy and the safety of a more extensive operation suggest that a pancreatic resection of 80 to 90% is warranted as an initial surgical approach. “Total” pancreatectomy should still be reserved for the surgical failures.

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    Regardless of the histologic confirmation of diagnosis, the common occurrence of recurrent nesidioblastosis after distal pancreatectomy has been described and suggests surgical therapy failure. Several series of open distal pancreatectomy in children for nesidioblastosis found that 100 (52%) of 193 patients had recurrent symptoms after resection and 61 (32%) required an additional resection to ameliorate their symptoms [36–43]. Nevertheless, 1 study differentiated the outcomes between 70% and 80% versus 95% distal pancreatectomy and found a second pancreatectomy rate of 42% versus 5%, respectively [38].

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Presented before the Surgical Section of the American Academy of Pediatrics, San Francisco, Calif., October 17–19, 1970.

Supported in part by USPHS Grant RR-00128.

1

Resident in Surgery, Children's Hospital Medical Center, Boston, Mass.

2

Associate Professor of Surgery, Children's Hospital Medical Center, Harvard Medical School, and Associate Chief of Surgery, Children's Hospital Medical Center, Boston, Mass.

3

Chief of Endocrinology and Metabolism, Department of Pediatrics, Brookdale Hospital Center, Brooklyn, N. Y.; formerly Assistant Physician, Endocrine Division, Department of Medicine, Children's Hospital Medical Center, Boston, Mass.

4

Associate Professor of Pediatrics at Children's Hospital Medical Center, Harvard Medical School, and Chief, Endocrine Division, Department of Medicine, Children's Hospital Medical Center, Boston, Mass.

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