Postpancreatectomy hemorrhage (PPH) - An International Study Group of Pancreatic Surgery (ISGPS) definition

University of Verona, Verona, Veneto, Italy
Surgery (Impact Factor: 3.38). 08/2007; 142(1):20-5. DOI: 10.1016/j.surg.2007.02.001
Source: PubMed


Postoperative hemorrhage is one of the most severe complications after pancreatic surgery. Due to the lack of an internationally accepted, universal definition of postpancreatectomy hemorrhage (PPH), the incidences reported in the literature vary considerably, even in reports from randomized controlled trials. Because of these variations in the definition of what constitutes a PPH, the incidences of its occurrence are not comparable.
The International Study Group of Pancreatic Surgery (ISGPS) developed an objective, generally applicable definition of PPH based on a literature review and consensus clinical experience.
Postpancreatectomy hemorrhage is defined by 3 parameters: onset, location, and severity. The onset is either early (< or =24 hours after the end of the index operation) or late (>24 hours). The location is either intraluminal or extraluminal. The severity of bleeding may be either mild or severe. Three different grades of PPH (grades A, B, and C) are defined according to the time of onset, site of bleeding, severity, and clinical impact.
An objective, universally accepted definition and clinical grading of PPH is important for the appropriate management and use of interventions in PPH. Such a definition also would allow comparisons of results from future clinical trials. Such standardized definitions are necessary to compare, in a nonpartisan manner, the outcomes of studies and the evaluation of novel operative treatment modalities in pancreatic surgery.

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Available from: Dirk J Gouma, Dec 08, 2014
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    • "PFs were identified by the presence of amylase-rich fluid of more than three times than the serum concentration collected from postoperative day 3 from the drain placed intraoperatively in the abdomen, in accordance with criteria defined by the International Study Group on Pancreatic Fistula (ISGPF) [14]. Haemorrhage was defined according to ISGPF criteria by three parameters, including onset, location and severity [15] and classified as Grade A, B or C. Sepsis was defined by the presence of both infection and systemic inflammatory response. "
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    • "Although it is not among the most frequent complications after pancreatectomy, it is considered life-threatening for its high mortality. Postpancreatectomy hemorrhage is defined as early, developing within 24 h from the operation, and late, developing 24 or more hours following the operation [1, 2]. "
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    ABSTRACT: Postpancreatectomy hemorrhage (PPH) and pancreatic fistula are main and serious complications following pancreaticoduodenectomy. Postpancreatectomy hemorrhage is considered life-threatening for its high rate of mortality. Postpancreatectomy hemorrhage is defined as early, occurring within 24 h after surgery, and late. The authors present a case of late PPH which developed in the third week following pylorus-preserving pancreaticoduodenectomy. A 58-year-old man was operated on for cancer of the pancreatic head. Hemorrhage occurred when the patient was in full health, convalescing at home. The cause was bleeding from a pseudoaneurysm of the stump of the gastroduodenal artery directly into the gastrointestinal tract. Diagnosis was established based on computed tomography angiography. Treatment was performed using minimally invasive technique during angiography. The implantation of a stent graft into the common hepatic artery for bridging the stump of the gastroduodenal artery was performed. This method thus enabled at once both diagnosis and successful minimally invasive treatment.
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    • "Postpancreatectomy hemorrhage (PPH) and delayed gastric emptying (DGE) were also defined based on the International Study Group of Pancreatic Surgery (ISGPS) definitions. [21, 22]. However, the definitions of ISGPS for POPF, PPH, and DGE were not published until 2004 and 2007, respectively. "
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