PMID- 15749601
OWN - NLM
STAT- MEDLINE
DCOM- 20050804
LR  - 20181113
IS  - 1091-255X (Print)
IS  - 1091-255X (Linking)
VI  - 9
IP  - 3
DP  - 2005 Mar
TI  - Laparoscopic surgery in patients with sporadic and multiple insulinomas 
      associated with multiple endocrine neoplasia type 1.
PG  - 381-8
AB  - There have recently been reports of a limited number of laparoscopic procedures 
      in patients with clinically manifest hyperinsulinism. However, the precise role 
      of laparoscopy remains unknown. Between January 1998 and September 2003, 11 
      consecutive patients (10 women and 1 man; mean age, 40 years; age range, 22-66 
      years) with sporadic insulinoma and two female patients (25 and 40 years old) 
      with multiple insulinomas associated with multiple endocrine neoplasia type 1 
      (MEN-1) were operated on using the laparoscopic approach. Endoscopic 
      ultrasonography was used to localize the tumor preoperatively in 90% of patients 
      with sporadic insulinoma. In patients with MEN-1, computed tomography and 
      octreoscan-(111)In demonstrated multiple tumors. Laparoscopic ultrasonography 
      (LapUS) was performed in all patients for operative decision-making. Of 11 
      patients with sporadic insulinoma, laparoscopic enucleation (LapEn) was planned 
      in 8 patients, but in 1 patient, the use of LapUS missed the tumor and the 
      patient was converted to open surgery. Mean operating time after LapEn (seven 
      patients) was 180 minutes, and the mean blood loss was 200 ml. The mean hospital 
      stay was 5 days. In three of the 11 patients, laparoscopic spleen-preserving 
      distal pancreatectomy (LapSPDP) was performed; the mean operative time was 240 
      minutes, and the mean blood loss was 360 ml. Postoperative complications occurred 
      in three of seven patients after LapEn (three pancreatic fistulas managed 
      conservatively, and one case of bleeding requiring reoperation). LapSPDP was 
      performed in both patients with MEN-1; in one patient with splenic vessel 
      preservation (SVP), the operating time was 210 minutes and blood loss was 650 ml, 
      with a hospital stay of 6 days. In another patient without SVP, the operating 
      time was 150 minutes and blood loss was 300 ml. The latter patient developed a 
      4-cm splenic infarct managed conservatively, and the hospital stay was 14 days. 
      LapEn and LapSPDP are feasible and safe and achieved cure in patients with 
      sporadic insulinoma and multiple insulinomas associated with MEN-1. However, the 
      risk of pancreatic leakage after LapEn remains high, and LapSPDP without SVP may 
      be associated with splenic infarct.
FAU - Fernandez-Cruz, Laureano
AU  - Fernandez-Cruz L
AD  - Department of Surgery, Institut Malaltivas Digestivas, Hospital Clinic i 
      Provincial de Barcelona, 08036 Barcelona, Spain. lfcruz@clinic.ub.es
FAU - Martinez, Isidro
AU  - Martinez I
FAU - Cesar-Borges, Gleydson
AU  - Cesar-Borges G
FAU - Astudillo, Emiliano
AU  - Astudillo E
FAU - Orduna, David
AU  - Orduna D
FAU - Halperin, Irene
AU  - Halperin I
FAU - Sesmilo, Gemma
AU  - Sesmilo G
FAU - Puig, Manuel
AU  - Puig M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Netherlands
TA  - J Gastrointest Surg
JT  - Journal of gastrointestinal surgery : official journal of the Society for Surgery 
      of the Alimentary Tract
JID - 9706084
SB  - IM
MH  - Adult
MH  - Aged
MH  - Biopsy, Needle
MH  - Cohort Studies
MH  - *Endosonography
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Immunohistochemistry
MH  - Insulinoma/complications/diagnostic imaging/pathology/*surgery
MH  - Laparoscopy/*methods
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Intraoperative
MH  - Multiple Endocrine Neoplasia Type 1/complications/diagnostic 
      imaging/pathology/*surgery
MH  - Neoplasm Staging
MH  - Pancreatectomy/methods
MH  - Pancreatic Function Tests
MH  - Pancreatic Neoplasms/complications/diagnostic imaging/pathology/*surgery
MH  - Postoperative Complications
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Survival Analysis
MH  - Treatment Outcome
EDAT- 2005/03/08 09:00
MHDA- 2005/08/05 09:00
CRDT- 2005/03/08 09:00
PHST- 2005/03/08 09:00 [pubmed]
PHST- 2005/08/05 09:00 [medline]
PHST- 2005/03/08 09:00 [entrez]
AID - S1091-255X(04)00248-3 [pii]
AID - 10.1016/j.gassur.2004.06.009 [doi]
PST - ppublish
SO  - J Gastrointest Surg. 2005 Mar;9(3):381-8. doi: 10.1016/j.gassur.2004.06.009.