Possibilities of laparoscopic interventions in children with pancreatic insulinomas

BACKROUND: Insulinoma is a tumor of β-cells of the islets of Langerhans, secreting an excessive amount of insulin, which is manifested by attacks of hypoglycemic symptoms Diagnosis of insulinomas localization in the pancreas can be extremely difficult and should include all available methods of radiation diagnosis. The only radical way to treat insulinoma is surgical. Traditionally, these operations were performed in the open version. There are only isolated publications on the performance of laparoscopic interventions in children with insulinomas. AIM: To present our experience of using laparoscopic technologies in the treatment of children with insulinomas of various localizations. MATERIALS AND METHODS: In the period from 2016 to 2023, 12 girls aged 7 to 17 years were operated on for pancreatic insulinoma. The average age of the patients was 12.5±3.1 years. RESUITS: All operations were completed in the laparoscopic version, there were no conversions. There were no intraoperative complications. In the early postoperative period, 3 children had complications. Parapancreatic fluid accumulations in 2 cases were drained by transgastric endoscopic fine needle puncture. After enucleation of insulinoma from the hookshaped process of the pancreas, 1 child developed focal pancreatic necrosis, which required pylori-preserving pancreatoduodenal resection. In all other cases, the postoperative period proceeded smoothly. All children have achieved a good clinical effect in the form of relief of symptoms and the absence of episodes of hypoglycemia. There was no recurrence of the disease in the period from 1.5 to 5 years. CONCLUSIONS: Experience shows that with the specified localization of insulinoma in the pancreas, laparoscopic operations can be performed using EUS and intraoperative sonography.