PRE- AND POSTOPERATIVE EVALUATION OF TISSUE ISCHEMIA MARKERS (LACTATE, SUCCINATE) IN RESECTED BOWEL SEGMENTS: CORRELATION WITH HISTOPATHOLOGY AND SURGICAL OUTCOME
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Keywords
Bowel ischemia, lactate, succinate, histopathology, ischemic biomarkers, surgical outcomes
Abstract
To evaluate pre- and postoperative serum lactate and succinate levels in patients undergoing bowel resection, and to correlate these markers with histopathological findings and surgical outcomes.
Methods: A prospective observational study was carried out at Bannu Medical College and its affiliated hospital from January 2023 to January 2024. A total of 72 patients undergoing bowel resection for ischemia or gangrene were included. Serum lactate and succinate levels were measured preoperatively and within 24 hours postoperatively. Resected specimens were examined for depth of ischemic necrosis and inflammatory changes. Postoperative outcomes, including complications, ICU stay, and mortality, were recorded. Statistical analysis included t-test, chi-square test, and Pearson’s correlation.
Results: Mean preoperative lactate was 4.2 ± 1.8 mmol/L, significantly reducing to 2.7 ± 1.1 mmol/L postoperatively (p = 0.001). Succinate showed a similar trend, declining from 8.9 ± 3.4 µmol/L to 5.6 ± 2.7 µmol/L (p = 0.003). Patients with transmural necrosis had significantly higher preoperative lactate (5.0 ± 1.9 mmol/L) and succinate (10.3 ± 3.1 µmol/L) compared to those with partial mucosal involvement. Elevated markers were also associated with higher rates of sepsis, anastomotic leak, prolonged ICU stay, and 30-day mortality (p < 0.05).
Conclusion: Both lactate and succinate are reliable markers of intestinal ischemia, with succinate showing a stronger correlation with histopathological severity. Incorporating these markers into routine assessment may aid in early diagnosis, guide surgical decision-making, and predict postoperative outcomes.
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Dr Tilal Ahmed Raza
Assistant Professor, Department of Surgical, Hayatabad Medical Complex, Peshawar, KPK, Pakistan
Dr Akhtar Ghani
Assistant Professor, Department of General Surgery, Bannu Medical College, Bannu, Pakistan
Dr Hamayun Mumtaz
Assistant Professor, Department of Chemical Pathology, Poonch Medical College, Rawalakot, Pakistan
Dr Aiman Khan
MPhil Scholar, Department of Histopathology, Khyber Medical University, Peshawar, Pakistan
Dr Safi Ullah
Consultant Anesthetist & Medical Officer In Charge of Surgical ICU, Operation Theatre & Surgical ICU, Combined Military Hospital (C.M.H) Sialkot, Pakistan
Dr Afshan Khattak
Consultant Chemical Pathologist, Department of Pathology, Indus Hospital & Health Network, Gwadar, Pakistan