Surgical aspects of hyperinsulinemic hypoglycemia

Surgical management of insulinoma begins with simply considering the diagnosis then proceeding to establish absolutely the biochemical diagnosis. Generally, the author prefers to limit preoperative localization to ultrasonography in the first-time exploration, but this may differ depending on which imaging study is locally most valuable. Surgical exploration must be thorough, gentle, precise, and is aided greatly by intraoperative ultrasonography. Enucleation is the author's preferred method of tumor excision, but partial pancreatectomy often is necessary. Cure has been achieved in more than 97% of cases in the last 16 years, and requires altered planning in patients with multiple endocrine neoplasia and nesidioblastosis.