BSPED2012 Poster Presentations (1) (66 abstracts)
Risk factors for short term post-operative complications after pancreatectomy for congenital hyperinsulinism
Bindu Avatapalle 1 , Mariam Albazi 1 , Charlotte Lance 1 , Lindsey Rigby 1 , Sarah Ehtisham 1 , Mars Skae 1 , Leena Patel 2 , Raja Padidela 1 , Jim Bruce 3 , Ross Craigie 3 , Indraneel Banerjee 2 & Peter Clayton 2
1Department of Paediatric Endocrinology, Manchester Children’s Hospital, Manchester, UK; 2Department of Paediatric Endocrinology, University of Manchester, Manchester Academic Health Sciences Centre, Manchester Children’s Hospital, Manchester, UK; 3Department of Paediatric Surgery, Manchester Children’s Hospital, Manchester, UK.
Introduction: Pancreatectomy may be necessary to treat hypoglycaemia due to congenital hyperinsulinism (CHI) following failure of medical management. Post-operative complications including infection and persistent hypoglycaemia have been reported after pancreatectomy, but factors predictive of these have not been recognised.
Aims: To investigate if early factors or the time to surgery predict risk of CHI surgical complications and hypoglycaemia in the 6 months after surgery.
Methods: A cohort of CHI patients (n=25) undergoing focal or subtotal pancreatectomy by laparatomy between 2003 and 2012 was retrospectively examined. CHI was characterised by age at presentation, KATP channel gene mutations (KATP) and focal/diffuse/insulinoma histology. Severity of CHI was assessed by maximum carbohydrate requirement (CHO), maximum dose of Diazoxide (Dz) and maximum glucagon infusion rate (Gl). Glycaemic outcome in the medium term was noted at 6 months after surgery.
Results: The median6 (range) age at presentation was 3 (1; 2920) days with time to surgery being 90 (30; 2765) days. KATP mutations were present in 20 (80%) children. 13 children (52%) had focal lesions, focal CHI (n=10) and insulinoma (n=3) confirmed by histology. As expected, KATP, CHO, Dz and Gl were correlated with an earlier time to surgery (R2=0.8, P<0.001). Surgical complications included infection, bleeding, chyle leak, wound dehiscence and pseudocyst in 7 (28%) children. The incidence of surgical complications was greater with delayed compared to earlier subtotal pancreatectomy (180 (69; 330) v 90 (30; 180), P=0.04), but not with focal lesionectomy (120 (30; 2765) v 75 (60; 90), P=0.4). Persistent hypoglycaemia requiring significant medication at 6 months occurred in 4 (16%) children with diffuse CHI requiring second surgery. KATP, CHO, Dz and Gl were not correlated with post-operative hypoglycaemia (R2=0.3, P=0.06). One child developed diabetes requiring insulin treatment.
Conclusions: A longer time to surgery, but not mutation status or severity at diagnosis of CHI, may predict risk for post-operative complications in children undergoing pancreatectomy.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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