Assoc. Prof. Mehmet Eren Yuksel
Ankara Etlik City Hospital, Surgical Critical Care Unit, Ankara, Türkiye
e-mail: doctormehmeteren@yahoo.com, ORCID: 0000-0002-7110-0717
HYPERTONIC
SALINE APPLICATION DURING HYDATID CYST SURGERY: RISK OF HYPERNATREMIA IN
POSTOPERATIVE SURGICAL CRITICAL CARE
Assoc. Prof. Mehmet Eren Yuksel
Ankara Etlik City Hospital, Surgical
Critical Care Unit, Ankara, Türkiye
e-mail: doctormehmeteren@yahoo.com, ORCID: 0000-0002-7110-0717
Introduction: Hydatid cyst
surgery, performed to treat disease caused by Echinococcus granulosus, involves
the use of protoscolicidal agents to eliminate protoscolices and prevent
recurrence. However, no protoscolicidal agent achieves the ideal balance of
efficacy and safety. Hypertonic saline (15–20%) is a widely used and effective
option, but its application carries risks, particularly hypernatremia,
requiring meticulous management during and after surgery.
Methods: This study
reviewed WHO guideline (Bulletin of the World Health
Organization, 1996) and clinical data to evaluate the role of protoscolicidal
agents in hydatid cyst surgery, focusing mainly on hypertonic saline.
Results: Protoscolicidal
agents such as 70–95% ethanol, 15–20% hypertonic saline, and 0.5% cetrimide
solution are effective when left in contact with cysts for at least 15 minutes.
However, challenges in vivo, including dilution by hydatid fluid and
difficulties penetrating daughter cysts, may reduce efficacy. Spillage into the
peritoneal cavity or excessive application of hypertonic saline can lead to
systemic absorption and hypernatremia. Symptoms range from seizures to coma and
cardiovascular instability. If the cyst communicates with the biliary tree,
applied protoscolicidal agents may cause chemical cholangitis, progressing to
sclerosing cholangitis.
Discussion and
Conclusion: Hypertonic saline is an option in hydatid cyst
surgery, demonstrating proven efficacy in eliminating protoscolices. However,
its use carries notable risks, particularly hypernatremia, underscoring the
need for strict adherence to established protocols. Controlled application
techniques and intraoperative sodium monitoring are essential to minimize
complications and ensure patient safety. To improve clinical outcomes, further
research should focus on developing safer and more effective alternatives to
current protoscolicidal agents.
Keywords: Echinococcus granulosus, hypertonic saline, hydatid cyst surgery, hypernatremia.
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