Pancreatic insulinoma: a surgical experience. 
Small size, high benignity rate, and sporadic nature make insulinomas suitable for laparoscopic resection.  On the other hand, occult location or multicentricity mandate open surgery.  This study was designed to analyze a series of patients who had pancreatic insulinomas and underwent initial treatment at our institution.  Clinical records of the 34 patients with pancreatic insulinomas who underwent surgical resection between 1995 and 2007 were reviewed.  Main variables for analysis were cure of the disease and surgical complications.  There were 20 women and 14 men with a mean age of 40 +/- 13 years.  Mean size of the tumors was 2.2 +/- 1 cm.  Laparoscopic resection was completed in 14 of 21 patients.  Most tumors that were resected by laparoscopy were solitary, benign, and located in the body and tail of the pancreas.  Open surgery was selected for 13 patients, including 7 sporadic (5 in the head), 4 related to the MEN syndrome, and 2 malignant tumors.  Surgical morbidity occurred in 23 patients.  The most common complication was pancreatic fistula (3/13 in open, 4/14 in laparoscopic, and 6/7 in conversions).  One patient in the open group died 15 days after surgery from massive PTE.  Postoperative normoglycemia was achieved in all patients and persisted for a follow-up period of 4 +/- 3.7 years.  Most insulinomas in our series were small and benign.  Tumors that were located in the body and tail were more often amenable for laparoscopic resection.  The cure rate was very high.  Pancreatic fistula was the most frequent complication.