Postoperative complications following surgery for congenital hyperinsulinism and insulinomas in pediatric patients.

Purpose: To systematically describe postoperative complications in surgery for HI in pediatric patients.

Methods: In this retrospective single-center study, we systematically analyzed the rate and grade of complications according to the Comprehensive Complication Index (CCI), Clavien-Dindo Classification (CDC), and the Clavien-Madadi Classification (CMC) in 74 patients undergoing a total of 89 surgeries for CHI (N = 68) or pediatric insulinomas (N = 6) at Odense University Hospital, Denmark, from 01.01.2010 until 01.10.2024.

Results: Patients surgically treated for focal CHI had more favorable surgical outcomes with a mean CCI score of 10.8 vs. the diffuse CHI mean CCI of 26.3 (p = 0.0018). Surgical treatment for pediatric insulinomas resulted in a mean CCI of 28.9. In the total group, the most common complication was postoperative infection (29%), followed by delayed gastric emptying (20%). The rate of postoperative pancreatic fistula was 11%, but only 3.4% were clinically relevant. Eight percent of the surgical procedures resulted in complications classified as CMD grade IIIb or higher.

Conclusion: Despite the complex nature of surgery in pediatric patients with CHI or insulinomas, the majority had an uneventful recovery. Severe complications (CMC grade IIIb +) were, however, seen in 8%. Prospective, systematic postoperative complication score evaluation is encouraged in surgery for pediatric HI.