The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After

Background: In 2005, the International Study Group of Pancreatic Fistula (ISGPF) developed a definition and grading of postoperative pancreatic fistula (POPF) that has been accepted universally. Eleven years later, because POPF remains one of the most relevant and harmful complications of pancreatic surgery, the ISGPF classification has become the gold standard in defining POPF in clinical practice. Methods: The ISGPF re-convened as the International Study Group in Pancreatic Surgery (ISGPS) in order to perform a review of the recent literature and consequently to update and revise the grading system of POPF. Results: The former “Grade A POPF” is now redefined and called a “biochemical leak (BL)”, because it has no clinical importance and is no longer referred to a true pancreatic fistula. POPF Grades B and C are confirmed but defined more strictly. In particular, Grade B requires a change in the postoperative management; drains are either left in place for more than three weeks or repositioned through endoscopic or percutaneous procedures. Grade C POPF refers to those POPF that require reoperation or lead to single or multiple organ failure and/or mortality attributable to the pancreatic fistula. Conclusion: This new definition and grading system of POPF should lead to a more universally consistent evaluation of surgical outcomes after pancreatic surgery and will allow for a better comparison of techniques used to mitigate the rate and clinical impact of a pancreatic fistula