Surgery for Persistent Hyperinsulinaemic Hypoglycaemia of Infancy

Conclusion

Intra-operative haemorrhage should not occur and the most frequently encountered problem is trauma to the bile duct. The duct may be injured only in the near-total resections — incidence of 12%. The injury can occur intra-operatively and, if detected, repaired immediately by direct suture or by choledochoduodenostomy. Late stricture from ischaemia can occur weeks to months post-operatively and these too require drainage by choledocho-enterostomy. Other complications include wound sepsis, adhesion intestinal obstruction and prolonged ileus. The long-term requirements for insulin therapy and exocrine pancreatic replacement need to be carefully assessed.