Is preoperative localization of insulinomas justified?

Study aim: To appreciate the impact of preoperative localization in surgica l treatment of insulinomas. Patients and method: From 1986 to 2001, 29 patients were surgically treated for suspected insulinoma. Preoperative imaging assessment was performed in 26 patients : ultrasonography (n=21), computed tomography (n=23), endoscop ic ultrasonography (n=13), intraoperative ultrasonography (n=22) (2 of them under laparoscopic approach). Results: The sensibility of the localization procedures was as follows: ult rasonography=9,6%, computed tomography=39%, endoscopic ultrasonography=92,3 %, surgical exploration79,3%, intraoperative ultrasonography 86,3%. The sen sibility of intraoperative palpation associated which intraoperative ultras onography was 100%. Surgical procedures included: 11 enucleations, 10 segme ntal resections of the tail, 1 left pancreatectomy, 3 median pancreatectomi es, 4 subtotal pancreatectomies. There was no postoperative mortality and p ostoperative morbidity rate was 17%, including 4 pancreatic leakages. Histo logical examination found solitary tumor in 22 patients (1 of them was a ma lignant tumor), multiple tumors (MEN 1) in 4 patients and facticious hypogl ycemia in 3 patients. All the insulinomas were resected. Conclusion: Intraoperative evaluation of the pancreas with intraoperative u ltrasonography was associated which a right localization in 100% of insulin omas. The place for preoperative imaging seems to be limited. A laparoscopi c approach in sporadic insulinomas could modify this attitude. (C) 2001 edi tions scientifiques et medicales Elsevier SAS.