title: Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: Moritz N
authors.initials: MN
authors.lastname: Wente
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Veit
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.forename: Christos
authors.initials: C
authors.lastname: Dervenis
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhut
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: John P
authors.initials: JP
authors.lastname: Neoptolemos
authors.forename: Robert T
authors.initials: RT
authors.lastname: Padbury
authors.forename: Michael G
authors.initials: MG
authors.lastname: Sarr
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D006801:Humans; D010180:Pancreatectomy / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology; D012720:Severity of Illness Index; D009626:Terminology as Topic; D013997:Time Factors