ArticleLangenbeck's archives of surgery2025
Post-Total-Pancreatectomy-Hemorrhage (PTPH) - approaching a new definition.
Article in Langenbeck's archives of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
purposePostoperative hemorrhagic complications in pancreatic surgery are classified according to the International Study Group for Pancreatic Surgery (ISGPS). However, following total pancreatectomy, the predominant bleeding causes associated with pancreatic fistula or insufficiency of the pancreatico-enteric anastomosis are eliminated. The objective of this study is to examine bleeding sources following total pancreatectomy, and propose a novel classification, termed Post-Total Pancreatectomy Hemorrhage (PTPH).
methodsAn overall of 195 patients was included and reviewed for baseline characteristics, comorbidities, intraoperative findings, perioperative coagulation profiles, and postoperative courses. Applicability of the ISGPS classification to PTPH was critically assessed with respect to the existing criteria: timely onset, location and cause, and severity. Subgroups were defined with regard to bleeding sources including erosion, surgical, gastrointestinal, and diffuse bleeding. Furthermore, we developed a severity index to enhance objectivity.
resultsThirty-five of the patients experienced hemorrhagic complications. Timely onset and our severity index corresponded significantly with the bleeding source.
conclusionThe ISGPS classification, although widely utilized in pancreatic surgery, does not fully account for the bleeding complications associated with total pancreatectomy. Our proposed classification for PTPH introduces a more granular and clinically relevant framework, with clearly delineated subgroups based on source, and an innovative severity index.
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