HYSTEROSCOPIC SURGERY - AVOID THE COMPLICATION OF HYPONATREMIC ENCEPHALOPATHY

Hysteroscopic surgery presents risks of four major complications: (1) hyponatraemic encephalopathy; (2) uterine perforation (either with or without bowel injury); (3) haemorrhage; (4) infection. To perform this procedure safely, the surgeon must be fully aware of the principles o f: (1) fluid management; (2) electrosurgery; (3) bleeding control. The most severe complication which confronts the surgeon in hysteroscopic surgery is neurological sequelae from hyponatraemic encephalopathy. P remenopausal women are 26 times more likely to suffer neurologic seque lae from hyponatraemia as post-menopausal women or men. These women su ffer permanent brain damage, paralysis and even death. To prevent this complication, premenopausal women should be transformed into post-men opausal women prior to the performance of a hysteroscopic operation us ing hyponatraemic fluids as distension media. This can be accomplished by giving GnRH agonists in sufficient quantity and for sufficient len gth of time to induce menopause. This paper presents a case reviewed b y the author of a young women in whom this was not done and who suffer ed;irreversible neurological consequences from hyponatraemia during a hysteroscopic resection of a small submucous myoma. In addition to the severe irreversible damage suffered by this previously healthy young woman; a jury awarded 24 million dollars in a judgement against the ph ysician and the surgery centre involved in her care. The medical and l egal consequences of complications-of what should be a simple and safe procedure may in fact be unacceptable it precautions are not taken to protect patients from the consequences of hyponatraemic encephalopath y.