Saturday, December 07, 2024

8. Uluslararası Sağlık Bilimleri ve Yaşam Kongresi 16-19 Nisan 2025

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
8. Uluslararası Sağlık Bilimleri ve Yaşam Kongresi 16-19 Nisan 2025

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.