Slide cricotracheoplasty: a novel surgical technique for congenital cricotracheal stenosis

Purpose: The aim of this study was to introduce a new surgical technique for the correction of congenital cricotracheal stenosis. Methods: A 5-day-old girl presented with esophageal atresia and congenital cricotracheal stenosis. After successfully correcting her esophageal atresia, the authors chose to use a type of slide cricotracheoplasty, which was a modification of slide tracheoplasty and anterior cricoid split. Results: The postoperative period was remarkably uneventful except for minor subcutaneous emphysema, and the midterm results were excellent. Conclusions: Slide cricotracheoplasty produced a good result and offered the same advantages as slide tracheoplasty. The authors believe that the described technique offers an efficient surgical procedure for the single-staged correction of congenital cricotracheal stenosis.     

Thoracoscopic repair of tracheoesophageal fistula in newborns

Background: Advancements in minimally invasive surgery in neonates have allowed even the most complex neonatal procedures to be approached using these techniques. Methods: During a period of 15 months, 8 patients born with a proximal esophageal atresia and a distal tracheoesophageal fistula underwent repair thoracoscopically. Weights ranged from 2.1 to 3.4 kg and operating times ranged from 55 to 120 minutes.Results: All procedures were completed successfully thoracoscopically, and there were no operative complications. One patient had a small leak on day 4 that resolved spontaneously on day 8. All other patients were shown to have a patent anastomosis with no leak by Barium swallow on day 5. Conclusion: This initial report shows that esophageal repair in the neonate is technically feasible and may provide advantages in terms of exposure and esophageal length, as well as the recognized advantages of avoiding a thoracotomy. J Pediatr Surg 37:869-872.     

Esophageal foreign body obstruction after esophageal atresia repair

Background/Purpose: The aim of this study was to determine the incidence and risk factors for esophageal foreign body obstruction (EFBO) after esophageal atresia/tracheoesophageal fistula (EA-TEF) repair. Methods: A Case-control chart review was conducted from 1987 to 1999. Results: EFBO occurred in 14 of 108 patients (13%) with EA-TEF. Mean follow-up was 31 months. Alimentary debris was the most common foreign body. Mean time between operation and EFBO was 25 months. EFBO recurred in 50%. Sixty-one percent of patients required endoscopic FB removal. Esophageal stenosis was present in 57% of EFBO patients, and 80% of stenoses presented initially with EFBO. The incidence of gastroesophageal reflux (GER; 50%), type C anomaly (100%), anastomotic leak (21%), major associated anomalies (50%), and encephalopathy (14%) were not significantly different between the EFBO group and the total EA-TEF population. There was no difference in the need for antireflux surgery (57%) between those with EFBO and GER and the total EA/TEF population with GER. Conclusions: Esophageal foreign body obstruction occurs in at least 13% of patients after EA-TEF repair. Because no reliable risk factors were identified that could predict foreign body obstruction, all families should be warned about this possibility during the first 5 years, particularly once the child begins eating solid foods.     

Fetal tracheal augmentation with cartilage engineered from bone marrow-derived mesenchymal progenitor cells

Background/Purpose: The authors have described previously the use of engineered fetal cartilage in a large animal model of fetal tracheal repair. This study was aimed at comparing cartilage engineered from bone marrow-derived stromal cells (BMSC) to native and engineered cartilage, in this model.Methods: Ovine BMSC were expanded in vitro, seeded onto biodegradable scaffolds, and maintained in transforming growth factor beta 1 (TGF-β1)-supplemented medium for 3 months (group I). Identical scaffolds were seeded with fetal chondrocytes (group II). All constructs were analyzed in vitro, implanted into fetal tracheas, and harvested after birth for further analysis.Results: There were no differences in survival between the groups. All BMSC-based constructs exhibited chondrogenic differentiation. Matrix analyses in vitro showed that both groups had similar levels of glycosaminoglycans (GAG) and type II collagen (C-II), but lower levels of elastin when compared with native fetal cartilage. Yet, compared with group II, group I had higher levels of GAG, equal levels of C-II, and lower levels of elastin. However, remodeling resulted in no differences between the 2 groups in any of these variables in vivo.Conclusions: The bone marrow may be a useful cell source for cartilage engineering aimed at the surgical repair of severe congenital tracheal anomalies, such as tracheal atresia and agenesis, in utero.     

Successful salvage of a long-standing collapsed lung by bronchoplasty in three children

Background: The authors report successful salvage of the ipsilateral lung by a bronchoplastic procedure in 3 patients with a long-standing, totally collapsed lung. Methods: The 3 patients were 1, 5, and 6 years of age, and the left lung had been collapsed totally for periods of 13 months to 5 years. The origin of atelectasis was congenital in 2 patients and traumatic in one patient. Bronchoscopy showed complete obstruction of the left main bronchus. In each patient, the left lung was small and appeared as a liverlike organ. Entire length of the main bronchus was resected. The left lung was not aerated in spite of aggressive bagging through an endotracheal tube inserted into the distal bronchial stump. The bifurcation of the upper and lower segmental bronchi was anastomosed to the trachea by interrupted sutures. Histology of the resected bronchus in the cases of congenital origin showed bronchial rings represented by islands of immature cartilage. Results: Chest x-ray showed complete aeration of the left lung at 3, 4, and 5 months, respectively, after surgery in the 3 children. Bronchoscopy disclosed a well-reconstructed airway in all patients. Two of the 3 patients have been free from respiratory distress during a 3- to 4-year follow-up. The latest patient to have this surgery is undergoing home ventilation because of chronic lung disease. Conclusions: A long-standing collapsed lung in children may reexpand if bronchial continuity is restored. Insufficient inflation of the lung at surgery is not an indication for pneumonectomy. When at all possible, a child's lung should be preserved.     

Long-term efficacy of partial splenic embolization in children

Purpose: To elucidate the role of partial splenic embolization (PSE) procedures, long-term outcome was assessed in terms of the recurrence of thrombocytopenia.Methods: A retrospective study was performed after 41 PSE procedures in 36 patients for hypersplenism owing to portal hypertension. The underlying disease was biliary atresia in 32 patients, extrahepatic portal obstruction in 3, and idiopathic cirrhosis in 1.Results: The average volume embolized was 70.1%. The patients were followed up from 20 days to 182 months (average, 70.8 months). Five patients subsequently died, and 6 underwent liver transplantation. The causes of death or the reasons for liver transplantation were not related to hypersplenism. Eleven patients (30.6%) had recurrence of thrombocytopenia (<100,000/mm³). There was no significant difference in the volume embolized or platelet count before PSE between the patients with and without recurrence of thrombocytopenia. The peak value of platelet count after PSE was significantly lower in the patients with recurrence of thrombocytopenia (P = .0091). In 17 of 24 survivors without liver transplantation, platelet counts remained normal throughout the follow-up period.Conclusions: PSE is a safe and effective procedure. Hematologic indices improved in all 36 patients after PSE, and its long-term efficacy was shown in 70% of the survivors.     

Bilious vomiting in the newborn: How often is it pathologic?

Background/Purpose: Intestinal obstruction is one of the most common reasons for admission to a neonatal surgical unit and frequently is manifest by bilious vomiting. Not all cases of neonatal bilious vomiting are caused by intestinal obstruction. This study aimed to investigate the outcome of neonates with bilious vomiting. Methods: A prospective audit was undertaken of all neonates with a history of bilious vomiting referred to a regional pediatric surgical unit during a 2-year period (1998 to 2000). Infants with bilious nasogastric aspirates but no vomiting were not included. Demographic details, symptomatology, investigations, and final diagnoses were recorded. Subsequent clinical progress was ascertained by out-patient review or telephone interview. Results: Sixty-three consecutive neonates (35 boys, 28 girls) were identified with a median gestational age of 40 (range 31 to 42) weeks and median birth weight of 3.5 kg (range 1.67 to 4.64). Median age at presentation was 26 hours (range, 9 hr to 28 days). A surgical cause of bilious vomiting was identified in 24 (38%): Hirschsprung's disease (n = 9), small bowel atresia (n = 5), intestinal malrotation (n = 4), meconium ileus (n = 3), meconium plug (n = 1), colonic atresia (n = 1), and milk inspissation (n = 1). Nineteen of these had both abdominal signs and an abnormal plain abdominal radiograph, and 4 had an abnormal abdominal radiograph only. In one infant with intestinal malrotation, clinical examination and plain radiography were unremarkable. After definitive surgery, all 24 infants were well at a median age of 14 (7 to 28) months. No surgical cause for bilious vomiting was found in 39 (62%) neonates whose symptoms resolved with conservative management. Conclusions: These data emphasize the maxim that bilious vomiting in the newborn should be attributed to intestinal obstruction until proved otherwise. However, in this prospective audit, bilious vomiting was not caused by intestinal obstruction in 62% of cases, and most of these infants suffered no further sequelae. J Pediatr Surg 37:909-911.     

Can 'long-gap' esophageal atresia be safely managed at home while awaiting anastomosis?

Background: Neonates with [ldquo ]long gap[rdquo ] esophageal atresia (EA) are often managed with gastrostomy and tube drainage of the proximal pouch for a number of months while awaiting definitive repair. Because of the risk of aspiration and need for complex nursing care, most remain hospitalized during this time. However, prolonged hospitalization utilizes scarce resources and may be difficult for many families. Methods: The authors report on 5 patients who were treated successfully at home while awaiting esophageal anastomosis. Results: Four patients had pure EA (one had a duodenal atresia), and one had a distal fistula. Gestational ages ranged from 31 to 41 weeks. All had a gastrostomy within days of birth. Age at definitive repair ranged from 6 to 12 months. Time at home while awaiting anastomosis ranged from 42 to 113 days. Care at home included nursing care, suction equipment and training, gastrostomy feeding, and ability to perform cardiopulmonary resuscitation. The only complications noted while at home consisted of ear infection in one patient and recurrent upper respiratory tract infections in another patient. Conclusions: Selected patients with long gap esophageal atresia can be treated safely at home while awaiting esophageal anastomosis. Success of this approach depends on a motivated, reliable family, and adequate support from community health care providers. J Pediatr Surg 38:705-708. [copy ] 2003 Elsevier Inc. All rights reserved.     

Management of congenital esophageal stenosis

Background/Purpose: The authors report the incidence, diagnosis, and treatment methods of congenital esophageal stenosis (CES) at their institution. Methods: A retrospective analysis of 123 patients with tracheoesophageal anomalies in a pediatric hospital between 1980 and 1999 was performed. Charts were reviewed for patient demographics, presence of true CES, associated congenital anomalies, method of diagnosis, methods of treatment, and histopathology. Results: Six of the 123 patients (4.9%) had true CES (one patient had 2 separate stenoses). Two patients had isolated CES, one patient had CES with isolated tracheoesophageal fistula (TEF), one patient had CES with isolated esophageal atresia (EA), and 2 patients had CES with EA/TEF. Diagnoses were made with an upper gastrointestinal (GI) contrast study in 5 patients, and one patient had one of 2 stenoses diagnosed by prenatal ultrasound and the other diagnosed intraoperatively. Four of the 7 stenoses were treated with surgical resection, and the remainder was treated with esophageal dilatation. Histopathology from the 4 resected stenoses showed tracheobronchial remnants in 3 specimens and submucosal thickening in 1 specimen. Conclusions: Although isolated CES is rare (2 of 123 = 1.6%), CES associated with other tracheoesophageal anomalies has a higher incidence (4 of 123 = 3.25%). Patients with this lesion should be treated first with dilatation. If ineffective, resection is required. J Pediatr Surg 37:1024-1026.     

Single umbilical artery and the VATER-animal model

Background/Purpose: Vascular disruption is recognized as a cause of congenital malformations. The authors analyzed the significance of single umbilical artery (SUA) in the Adriamycin-animal model to find out if it was associated with organ malformations.Methods: Pregnant SD rats were injected with Adriamycin intraperitoneally at a dose of 2 mg/kg on days 6 through 9 of gestation. Serial transverse sections of full-term fetuses were analyzed by light microscopy. Embryos also were removed on different gestational days during organogenesis, and serial transverse histologic sections were examined and compared with suitable controls.Results: In experimental embryos (n = 47), presence of a SUA resulted from either persistence of the primitive umbilical arteries that joined each other ventral to the hind gut to give rise to one umbilical artery or from secondary atrophy of one of the definitive umbilical arteries. Malformations such as intestinal atresia were associated with anomalous fusion between the dorsal aorta and the persistent primitive umbilical arteries.Conclusions: SUA is a prominent feature of the Adriamycin-animal model. No obvious association was found between malformations and SUA that resulted from atrophy of one of the definitive umbilical arteries; however, it was associated with anomalies such as intestinal atresia when it resulted from persistence of the primitive umbilical arteries.     

Usefulness of endoscopic ultrasonography in the diagnosis of congenital esophageal stenosis

Background/Purpose: Endoscopic ultrasonography (EUS) is considered a potentially useful tool to investigate structural abnormalities of the esophagus in pediatric patients, as in adults. The aim of this study was to evaluate the usefulness of EUS for the diagnosis of congenital esophageal stenosis. Methods: High-frequency catheter probe EUS was performed under general anesthesia in 2 patients who had congenital esophageal stenosis. Results: A 4-year-old boy with anorectal anomaly showed tapered narrowing in the distal esophagus, which was not ameliorated with balloon dilatation. High-frequency catheter probe EUS showed hypertrophy of the muscular layer in the esophageal wall at the narrowed portion, but no images suggested the presence of tracheobronchial remnants. The histologic diagnosis of fibromuscular hypertrophy was confirmed at esophagoplasty. A 5-month-old boy with Gross C-type esophageal atresia and symptomatic gastroesophageal reflux showed tapered narrowing in the middle esophagus on esophagography. The symptoms of stenosis were not ameliorated by balloon dilatation performed 4 times. High-frequency catheter probe EUS showed hyperechoic lesions suggesting cartilage at the esophageal narrowing. The diagnosis of tracheobronchial remnants was confirmed by the finding of 2 pieces of cartilage in the specimen obtained at the time of esophageal resection. Conclusion: EUS can be applied to show structural abnormalities of the esophageal wall even in pediatric patients with congenital esophageal stenosis and is useful for planning the therapeutic strategy.     

Excellent long-term outcome for survivors of apple peel atresia

Background: Apple peel atresia is the rarest type of small bowel atresia. Because of its rare occurrence and high mortality rate, little is known about the long-term outcome of these children. Methods: The patient charts, operative reports, and office notes of 15 children with apple peel atresia from 6 pediatric surgical centers in the Netherlands were reviewed. Long-term follow-up was assessed through review of office notes and through questionnaires. Results: The median age at the time of operation was 1.5 days. Postoperatively, 53% suffered from cholestasis, and 40% were septic. Three patients died (20%). At follow-up at a median age of 24 months, 1 child showed growth retardation and 2 children suffered from short bowel syndrome. At the time of the questionnaire, all children showed normal growth and development. Conclusions: Even though children with apple peel atresia often suffer serious morbidity like short bowel syndrome and sepsis during the postoperative course, late morbidity turned out to be low. If the patients survive the operative and direct postoperative period, and survive the morbidity associated with malnutrition and the long-term use of total parenteral nutrition, they have a good chance of having normal bowel function with normal growth and development.     

Triangular tapered duodenoplasty for the treatment of congenital duodenal obstruction

Background/Purpose: To evaluate the safety and efficiency of triangular tapered duodenoplasty, a modified procedure for the treatment of congenital duodenal obstruction was designed. Methods: Eight children underwent triangular tapered duodenoplasty over a 5-year period with a minimum follow-up of 27-months. Study parameters include morbidity and mortality postsurgical time to feedings, hospital length of stay, and weight gain. In addition, all patients were asked to undergo postoperative gastric emptying scans and upper gastrointestinal series (UGIS). Results: Eight children underwent triangular tapered duodenoplasty with 0% surgical morbidity and mortality rates. Mean postsurgical time to feedmap was 5.7 days (range, 2 to 12 days), and mean hospital length of stay was 9.6 days (range, 4 to 15 days). Mean NCHS weight gain was 50% (range, 25% to 75%). Five patients underwent postoperative gastric emptying scans with a mean Tc 43 minutes (range, 24 to 70 minutes; normal, 50 minutes). Four patients underwent postoperative UGIS showing no evidence of megaduodenum in any patient. Conclusions: Triangular tapered duodenoplasty is safe and effective in the treatment of congenital duodenal obstruction. The morbidity and mortality rates and hospital stay resulting from this procedure are the lowest as yet reported in the medical literature. J Pediatr Surg 37:862-864.     

Minimally invasive management of the prenatally torsed ovarian cyst

Background: Fetal and neonatal ovarian cysts are detected frequently by ultrasonography. The presence of these lesions can result in adnexal torsion in utero with autoamputation. Historically, these have been removed at laparotomy. Methods: Retrospective chart review was performed at a single children's hospital from October 1996 to September 2001. Results: Six cases of torsion of ovarian cysts were removed laparoscopically. Five of the 6 patients had prenatal ultrasound diagnosis. The sixth had the cyst detected incidentally by magnetic resonance imaging (MRI) at 3 months of age. All cysts were complex by ultrasound criteria. All 6 procedures were performed via a 2-port laparoscopic approach. The average age at surgery was 3.7 months (range, 9 days to 7.5 months). There were no postoperative complications. Five patients were discharged on the day of surgery. Conclusion: Laparoscopy offers a safe, effective, and cosmetic means of managing perinatal torsion of ovarian cysts. J Pediatr Surg 37:1467-1469.     

Cystic anomalies of biliary tree in the fetus: is it possible to make a more specific prenatal diagnosis?

Background/Purpose: Biliary tree cystic malformations (BCM) occur rarely. Current progress in ultrasonography makes it possible to identify them prenatally. The aim of this study was to analyze retrospectively prenatal ultrasound patterns of 5 consecutive subhepatic cysts in an effort to differentiate the BCM before birth and onset of symptoms. Methods: The prenatal ultrasound patterns of 5 consecutive BCM were correlated with the postnatal diagnosis. Results: Case 1 showed a hyperechogenic cyst that underwent enlargement during fetal life; the diagnosis at birth was an obstructed choledochal cyst (CC). In cases 2 and 3, an anechoic cyst with small, stable dimensions during pregnancy was identified; a biliary atresia (BA) type III-C was confirmed at birth. A slightly hyperechogenic cyst with no increase in size at repeated prenatal scans, was observed in cases 4 and 5; a CC and a cystic lesion at the confluence of the hepatic ducts (without obstruction) were diagnosed postnatally, respectively. Conclusions: The ultrasound scan pattern and size allow to make a prenatal differential diagnosis of BCM. Anechoic, small cyst in the hepatic hilum is highly suspicious for BA. Large, echoic or enlarging cyst is strongly suggestive of [ldquo ]obstructed[rdquo ] CC. Echoic, small and stable cyst is more suggestive of [ldquo ]unobstructed[rdquo ] CC. J Pediatr Surg 37:1191-1194.     

Thoracic outlet syndrome in paediatrics: clinical presentation,surgical treatment,and outcome in a series of eight children

Background/Purpose: This report reviews the clinical presentation, surgical treatment, and outcome of 8 children treated for the thoracic outlet syndrome (TOS) during the last 3 years. Methods: From 1998 through 2001 31 patients were admitted to our Vascular Surgery Unit with TOS. Eight of them (25.8%) were in the paediatric age group, 8 to 16 years (mean, 13 years). No sex prevalence was found. The presenting symptoms were neurologic in 2 patients (25%) and secondary to venous flow impairment in 6 (75%). At phlebography, venous thrombosis was seen in 2 cases, and functional intermittent obstruction was seen in 4. Seven patients underwent decompressive surgical partial resection of the first rib with transaxillary or supraclavicular access. One patient was treated conservatively. Results: There were no major postoperative complications. Mean hospital stay was 2.7 days. In no patient were there signs of recurrence after a mean follow-up of 18 months (range, 3 to 36 months). Conclusions: In the authors' experience TOS in paediatric patients occurs with the same symptoms and thrombotic complications as in adults. The same surgical strategy adopted in adult patients is advisable for affected children. J Pediatr Surg 38:58-61.     

Strategy of management for congenital biliary dilatation in early infancy

Purpose: The aim of this study was to establish the optimal management strategy of congenital biliary dilatation (CBD) in early infancy. Methods: Over the last 15 years, 14 patients with CBD in early infancy (within 5 months), including 3 antenatally diagnosed patients, were treated in the authors' department. Of the 14 patients, 7 (50%) underwent early definitive surgery (E group), and the other 7 (50%) underwent delayed primary definitive surgery after percutaneous transhepatic cholangiodrainage (PTCD; D group). Both groups were compared retrospectively using clinical data. Results: Pretreatment status and backgrounds of the patients were clinically homogeneous between the 2 groups. The total length of hospital stay was significantly longer in the D group. As short-term complications, 1 patient in the E group was compromised with hepatolithiasis, and 3 patients in the D group were compromised with catheter-related complications. Other clinical data, such as age at definitive surgery, blood loss, pathologic fibrosis of the liver, jaundice-free day, and long-term complications were not significantly different between the 2 groups. Conclusions: The authors propose that the standard of management should be early definitive surgery with wide anastomosis before 2 months of age. However, PTCD might be used under strict consideration of indication and careful management for patients with extremely poor surgical risk. J Pediatr Surg 37:1173-1176.     

Submucosal pressure-air insufflation facilitates endorectal mucosectomy in transanal endorectal pull-through procedure in patients with Hirschsprung's disease

Background: Most children with Hirschsprung's disease (HD) can be treated with a transanal endorectal pull-through (TEP) procedure. The authors have developed a simple technique of submucosal pressure-air insufflation (SI) to facilitate the submucosal dissection, which is one of the crucial parts of the operation. Methods: Six patients with HD were treated by using TEP in one year. After adequate positioning and exposure, anal mucosa was incised 1 cm above the dentate line, and 4-quadrant SI with a simple system of scalp-vein needle connected to a 20-mL syringe was used in all of the patients. Submucosal proctectomy, aganglionic and dilated segment colectomy, and coloanal anastomosis were completed transanally, but, in 2 of the patients, laparoscopic assistance to release the colon was required. Results: There were no intraoperative and postoperative complications related to SI. Submucosal dissections were completed smoothly in all of the patients with negligible amount of bleeding. The only complication during the submucosal dissection was mucosal perforation at the site of previous rectal biopsy in 2 patients. Average operating time was 2.7 hours (range, 90-180 min), and mean length of resected bowel was 22.5 cm (range, 12 to 42 cm). Follow-up is 8 to 14 months. Frequent bowel movements ([gt ]8 times per day) and perianal dermatitis were observed in 2 patients but returned to acceptable limits in 3 months. One patient had to undergo reoperation for adhesive intestinal obstruction. Conclusions: SI is simple, and offers a safe and faster dissection with minimum amount of bleeding during the endorectal mucosectomy in TEP procedure. J Pediatr Surg 38:188-190.     

Balloon catheter dilatation in children with congenital and acquired esophageal anomalies

Background/Purpose: Esophageal stricture requiring dilatation often is the sequelae in children with a history of congenital or acquired esophageal anomalies. Balloon catheter dilatation (BCD) for esophageal stricture is well established in adults, yet its role in children is less well described. The authors report their initial experience using BCD in children with esophageal stricture, assessing outcome. Methods: Between January 1994, and December 1998, 20 children (age range, 17 days to 12 years) underwent BCD for esophageal strictures and were divided into 2 etiology groups (A and B). (A, n = 10) included congenital anomalies (esophageal atresia, 10), and (B, n = 10) included acquired anomalies (caustic ingestion, 7; tight fundoplication, 2; peptic stricture, 1). BCD was performed in all cases under conscious sedation with a balloon catheter (6 to 25 mm) with fluoroscopy. Outcome parameters included number of dilatations; complications, ie, perforation; and success or failure of procedure. Success was defined as increasing intervals of age-appropriate food tolerance between dilatations, and failure was defined as abandonment of dilatation in favor of surgical intervention. Follow-up for A and B ranged from 6 to 42 months. Results: Seventeen of 20 (85.0%) underwent successful BCD. In A, 10 of 10 (100%) had complete resolution of symptoms with follow-up ranging from 6 to 42 months versus 7 of 10 (70.0%) in B with follow-up of 6.5 to 36 months. In A, number of dilatations ranged from 1 to 4 over an average period of 2 months. In B, number of dilatations ranged from 3 to 40 over periods ranging from 2 to 30 months. All 3 failures occurred in children with caustic ingestion, with 1 child suffering perforation requiring urgent surgical intervention. Conclusions: Balloon catheter dilatation can be applied safely and effectively to children in whom esophageal strictures develop after repair of esophageal atresia. However, its use in children with acquired esophageal anomalies, notably caustic injury, is associated with higher complication and failure rates, necessitating greater caution and lower expectations.     

Surgical complications of pancreatectomy for persistent hyperinsulinaemic hypoglycaemia of infancy

Purpose: The aim of this study was to review the surgical complications of pancreatectomy for persistent hyperinsulinaemic hypoglycaemia of infancy (PHHI). Methods: A retrospective review was conducted of patients undergoing pancreatectomy for PHHI in one institution over the past 13 years. Results: The records of 48 patients were reviewed; the age at operation ranged from 10 days to 30 months (median, 8 weeks). Weight at operation ranged from 1.97 to 11.4 kg (median, 5.2 kg). There were no deaths. Intraoperative complications comprised bleeding in 7, (major in 2), splenic injury in one, bile duct injury in 2 (1 oversewn, 1 choledochoduodenostomy), and 1 small bowel injury. Postoperatively, 5 children underwent choledochoduodenostomy: 2 for biliary leak and 3 for delayed bile duct stricture. Other postoperative complications included wound infection (n = 3), prolonged ileus (n = 1) and adhesion obstruction (n = 1), and wound leakage (n = 1). Renal failure developed in one child owing to acute tubular necrosis. Nine patients required further pancreatic resection because of continued hypoglycaemia. Three patients continued to require medication for hyperinsulinism despite surgery, 20 required insulin, and 13 required pancreatic enzyme replacement at the time of the last review. Conclusions: Pancreatectomy resulted in resolution of hyperinsulinism in 45 of 48 patients. Sixteen patients required no further surgery or medication. Pancreatectomy for PHHI may be associated with major intra and postoperative morbidity. J Pediatr Surg 38:13-16.