Document Type : Original Article
Pediatric Surgery Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Surgery, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
Department of Pediatric Surgery, Abouzar Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahwaz, Iran
Mardani Azar Pediatric Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
Neonatal Health Research Center, Mofid Children’s Hospital, Shahid Beheshti Medical University of Medical Sciences, Tehran, Iran
Background: Congenital hyperinsulinism (CH) is a well-known cause of the persistent neonatal hypoglycemic state that may lead to irreversible neurological damage. While medical therapy can improve the condition in some cases, refractory cases require further investigation to identify focal or diffuse pancreatic lesions. Surgery is the main treatment for refractory cases and can improve the neurological and glycemic status of patients. The study aimed to evaluate the short-term outcomes of surgical intervention in cases of CH who underwent surgical treatment.
Methods: A multicenter cross-sectional survey was conducted to review cases of CH that underwent surgery between 2018 and 2020. Focal cases were treated with simple enucleation or distal pancreatectomy, while diffuse cases underwent near-total pancreatectomy. The glycemic and neurological states of the patients were evaluated and the results were analyzed.
Results: Among the 56 neonates who underwent pancreatic surgery, 48 (85%) had diffuse disease, and the remaining cases suffered from focal lesions. All focal cases achieved normoglycemia, while 24 (50%) of the diffuse cases achieved normal glycemic levels (P≤0.003). Additionally, the incidence of irreversible neurological deficits was higher in the diffuse group (P=0.029).
Conclusion: The focal form of CH seems to be totally curative by surgical operations. However, the proper management of diffuse form is still demanding. Although in our study, we had an acceptable success rate in the short-term, lifelong euglycemia may not be obtainable in these patients.