Indocyanine green fluorescence cholangiography enables safe laparoscopic near-total pancreatectomy for diffuse congenital hyperinsulinism.

AIM: Laparoscopic near-total pancreatectomy (NTP) for diffuse congenital hyperinsulinism (CHI) may reduce morbidity compared with open surgery. However, it is technically limited by uncertainty regarding the intrapancreatic common bile duct (CBD) course, risking bile duct injury or inadequate resection. We evaluated whether near-infrared indocyanine green fluorescence cholangiography (NIR ICG FC) improves intraoperative identification of the intrapancreatic CBD and supports laparoscopic NTP for medically-refractory diffuse CHI.

METHODS

We performed a retrospective single-centre review of consecutive infants undergoing laparoscopic NTP with NIR ICG FC for diffuse CHI (2021-2025). Intravenous ICG (0.5 mg/kg) was administered 10-15 h preoperatively. Outcomes included feasibility of CBD visualisation, extent of resection, biliary complications, postoperative recovery, persistence of hyperinsulinism and medium-term endocrine/exocrine function.

RESULTS

Five infants underwent laparoscopic NTP at a median age of 3 months (range 2-6). The intrapancreatic CBD was visualised in all cases, enabling a consistent 95% resection without conversion to open surgery. There were no bile duct injuries. Enteral feeding commenced at a median of 3 postoperative days (range 2-4). One patient developed transient obstructive jaundice on postoperative day 13 that resolved with conservative management. At a median follow-up of 30 months (range 20-51), three infants had residual hyperinsulinism (managed by feeding strategies in two and medication in one), and one had exocrine insufficiency requiring enzyme supplementation; no child had diabetes at latest follow up.

CONCLUSION

NIR ICG fluorescence cholangiography provides real time delineation of the intrapancreatic CBD and can support a safe minimally invasive approach to near-total pancreatectomy for diffuse CHI.