Insulinoma of the pancreatic head: results from two surgical strategies.

A rare location of insulin-secreting pancreatic tumour, which presents technical difficulties, is centrally in the pancreatic head close to the duodenal wall. Local excision or enucleation gives very high postoperative morbidity, with pseudocyst and fistula, and more extensive surgery such as pancreatoduodenectomy has a high mortality rate in these patients. At Linköping University Hospital, five patients with insulinoma at this particular site were diagnosed and operated on in 1978-84. After excision of the tumour, the enucleation cavity was treated with one of two surgical strategies--closure and drainage (3 cases) or drainage only (2 cases). The postoperative course differed greatly between the two groups. The experience from these cases suggests that endocrine tumours at this site in the pancreas can be excised locally, with strict safeguarding of the pancreatic duct, but that the cavity in the pancreas should be left open with long-term drainage.