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Although preoperative biliary stents may complicate the intraoperative management and lessen the postoperative complications of patients undergoing pancreaticoduodenectomy, only estimated blood loss and reoperation were significantly different in this cohort. Further study may reveal patient subgroups who may specifically benefit or suffer from preoperative biliary stenting. Currently, selective preoperative BD appears appropriate in the multidisciplinary management of patients with periampullary lesions.

Background Noninsulinoma pancreatogenous hypoglycemia (NIPH) is a rare cause of hypoglycemia from excessive insulin secretion, especially affecting post-bariatric surgery patients. Partial pancreatectomy may control hypoglycemia; however, multiple patients experienced symptomatic relapse. Our study goal was to assess frequency and severity of recurrent symptoms postoperatively. Methods Demographics, preoperative testing, operative and postoperative details were reviewed for all patients who underwent pancreatic resection for NIPH at Mayo Clinic from January 1996 - December 2008. Patient records and mail surveys (including European Quality of Life Survey (EQ-5D) and Fear of Hypoglycemia Scale (FOHS-98)) were used to assess outcome. Results 75 patients underwent pancreatic resection for NIPH. 48 patients (70%) completed the survey (median follow-up 53 mo.). Median time to recurrent symptoms was 16 months (N=41, 87%). Despite symptom recurrence, 75% of patients reported overall improvement in quality of life, with marked reduction in psychological stress and hypoglycemic symptoms (greater than 50% decrease in FOHS-98 scores (p<0.001). Overall, half of the patients were classified as highly/moderately surgically-successful. Nevertheless, 25% of patients experienced no apparent benefit. Conclusions Although nearly 90% of NIPH patients reported recurrent symptoms suggestive of hypoglycemia, a majority reported significant improvements in QOL and marked reduction in other symptoms after pancreatic resection.

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