ABSTRACT
Partial pancreatectomy is indicated as a curative procedure in all cases of focal hyperinsulinism (HI). On the other hand, near-total pancreatectomy is indicated in some genetic variants of diffuse HI, with the goal of decreasing severity of disease. After confirming the diagnosis of diffuse disease by pancreatic biopsies with frozen section, the pancreatectomy starts by carefully dissecting the tail of the pancreas off the splenic hilum. The dissection of the pancreatic head off proximal and distal duodenum, and off the medial aspect of the common bile duct (CBD) completes the near-total pancreatectomy. Generally, lumen of proximal cut end of the pancreatic duct is not visible and there is no need to formally close it, but, if there is any concern for potential leak. A high rate of CBD injury has been observed in cases of laparoscopic near-total pancreatectomy to treat diffuse disease. Postoperative pain after open pancreatectomy is best managed by epidural catheter placed prior to operation, and IV narcotics.
