Post-Total-Pancreatectomy-Hemorrhage (PTPH) - approaching a new definition.

Purpose: Postoperative 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).

Methods: An 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.

Results: Thirty-five of the patients experienced hemorrhagic complications. Timely onset and our severity index corresponded significantly with the bleeding source.

Conclusion: The 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.