Postpancreatectomy Acute Pancreatitis (PPAP): Definition and Grading from the International Study Group for Pancreatic Surgery (ISGPS)

Giovanni Marchegiani, Savio George Barreto, Elisa Bannone, Michael Sarr, Charles M. Vollmer, Saxon Connor, Massimo Falconi, Marc G. Besselink, Roberto Salvia, Christopher L. Wolfgang, Nicholas J. Zyromski, Charles J. Yeo, Mustapha Adham, Ajith K. Siriwardena, Kyoichi Takaori, Mohammad Abu Hilal, Martin Loos, Pascal Probst, Thilo Hackert, Oliver StrobelOlivier R.C. Busch, Keith D. Lillemoe, Yi Miao, Christopher M. Halloran, Jens Werner, Helmut Friess, Jakob R. Izbicki, Maximillian Bockhorn, Yogesh K. Vashist, Kevin Conlon, Ioannis Passas, Luca Gianotti, Marco Del Chiaro, Richard D. Schulick, Marco Montorsi, Attila Oláh, Giuseppe Kito Fusai, Alejandro Serrablo, Alessandro Zerbi, Abe Fingerhut, Roland Andersson, Robert Padbury, Christos Dervenis, John P. Neoptolemos, Claudio Bassi, Markus W. Büchler, Shailesh V. Shrikhande

Research output: Contribution to journalReview articlepeer-review

60 Scopus citations


Objective:The ISGPS aimed to develop a universally accepted definition for PPAP for standardized reporting and outcome comparison.Background::PPAP is an increasingly recognized complication after partial pancreatic resections, but its incidence and clinical impact, and even its existence are variable because an internationally accepted consensus definition and grading system are lacking.Methods:The ISGPS developed a consensus definition and grading of PPAP with its members after an evidence review and after a series of discussions and multiple revisions from April 2020 to May 2021.Results:We defined PPAP as an acute inflammatory condition of the pancreatic remnant beginning within the first 3 postoperative days after a partial pancreatic resection. The diagnosis requires (1) a sustained postoperative serum hyperamylasemia (POH) greater than the institutional upper limit of normal for at least the first 48 hours postoperatively, (2) associated with clinically relevant features, and (3) radiologic alterations consistent with PPAP. Three different PPAP grades were defined based on the clinical impact: (1) grade postoperative hyperamylasemia, biochemical changes only; (2) grade B, mild or moderate complications; and (3) grade C, severe life-threatening complications.Discussions:The present definition and grading scale of PPAP, based on biochemical, radiologic, and clinical criteria, are instrumental for a better understanding of PPAP and the spectrum of postoperative complications related to this emerging entity. The current terminology will serve as a reference point for standard assessment and lend itself to developing specific treatments and prevention strategies.

Original languageEnglish
Pages (from-to)663-672
Number of pages10
JournalAnnals of Surgery
Issue number4
StatePublished - 1 Apr 2022
Externally publishedYes


  • International Study Group for Pancreatic Surgery
  • definition
  • postpancreatectomy acute pancreatitis
  • postpancreatectomy acute pancreatitis


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