Surgical Considerations Related to Diving

General Guidelines

  • Consider the illness or condition being operated upon and any relationship to the diving environment
  • Consider the physical limitations imposed as a result of the operation
    • Short term:
      Rate of wound healing of the specific body system
      Complications (infection, wound disruption, temporary loss of function)
    • Long term:
      Disability from any source reducing the diver’s functional ability.
  • Implants of any nature
    Any implant that does not contain air or gas should not be a contraindication to diving. This includes all metallic, silicone, composite and fluid filled sacs. These objects are not compressible and therefore pose no danger to the diver. Any air or gas filled implant, such as an artificial eye or any other reconstructive body part is at hazard to explode or rupture due to the action of Boyle’s Law.
  • Return to diving after surgery
    • Neurological System
      Link includes ‘Brain, shunt surgery, herniated disc’
    • Eye
      Link includes ‘Diving after Eye Surgery’, ‘Post-surgical Waiting Period’
    • ENT
      Absolute post-operative contraindications
      Tympanoplasty, other than myringoplasty (Type I)
      History of stapedectomy [This is being debated at this time].

      Most recently there have been good studies to show that stapedectomy is not the risk that
      was once thought.

      See this article:

      Otolaryngol Head Neck Surg 2001 Oct;125(4):356-60
      Diving after stapedectomy: clinical experience and recommendations.
      House JW, Toh EH, Perez A.
      Clinical Studies Department, House Ear Clinic and Institute, 2100 West Third
      Street, Los Angeles, CA 90057, USA.

      CONCLUSIONS: Stapedectomy does not appear to increase the risk of inner ear
      barotrauma in scuba and sky divers. These activities may be pursued with
      relative safety after stapes surgery, provided adequate eustachian tube
      function has been established.

      History of inner ear surgery
      Status post laryngectomy or partial laryngectomy
      Radical mastoidectomy (posterior) involving the external canal is
      disqualifying. (Closed childhood OK)
      Tracheostomy, tracheostoma
      Incompetent larynx due to surgery (Cannot close for valsalva
      maneuver)

  • Heart
    Cardiac and valvular surgery
    Surgery without entering the chest cavity; six to eight weeks or whenever the diver has physically rehabilitated to reach 13 METS on the treadmill.
    Surgery with entry into the chest for whatever reason; see thoracotomy.
    Patent Foramen Ovale – A button closure (Amplatzer) is performed trans venously without entering the chest. Four weeks after the surgery, another echocardiogram is done to verify that the device is still in position. After two-three weeks there is an overgrowth of endothelial cells covering the device, reducing the risk of infection. After six to eight weeks the connective tissue has completely filled the spaces in the device and it becomes invisible to ultrasound. Return to diving is usually in six weeks (Wilmshurst), given the full recovery to the satisfaction of the cardiologist/surgeon. Others require a longer wait of twelve weeks.
    See article by Wilmshurst, et al at http://heart.bmjjournals.com/cgi/content/full/81/3/257 .
  • Pulmonary, Thoracotomy
    Patients with a thoracotomy can be certified for diving after thorough evaluation by a thoracic surgeon knowledgeable of diving medicine. Post operative wait of 12 weeks; surgical release recommended. Should be studied to rule out air trapping.
    Lobectomy or pneumonectomy patients usually fill in the ‘dead space’ from the loss of tissue with fluid and scar. Depending on the cause of the surgery, postoperative course and results of pulmonary function and scans a person might be allowed to return to diving with the approval of their physician.
    Divers with pulmonary barotrauma may return to diving after no less than a three month wait and a certification from a diving physician that there is no air trapping.
  • Gastrointestinal
    A history of bowel obstruction is not disqualifying if the person is asymptomatic 3 months after corrective surgery. Wait six to 12 weeks postoperative before diving. Surgeon’s advice recommended.
    The postoperative wait after laparotomy depends greatly upon the cause for the surgery and the extent of surgery involved. A postoperative wait of six to twelve weeks is recommended, again with the approval of the diver’s surgeon. Continent urostomy or ileostomy contraindicates diving because of Boyle’s law.
    A hernia that includes bowel is disqualifying until surgically repaired. A wait of 6 weeks is suggested for the simple repair. Advice of surgeon suggested.
  • Bone & Joint
    Prostheses, joint surgery, fractures
    Return to diving is entirely dependent on evidence of complete healing. Weight-bearing with 100 plus pounds of gear, exits and entries should be carefully considered by the surgeon before certifying return to diving. The effects of pressure and bubbling on the operative site are unknown at this time.

General Advice About Diving

Whether or not a person having had surgery should be certified as ‘fit to dive’ should be decided on the merits of each case, the type of surgery required, if symtomatic or on medication, and the length of time postoperative free of problems. Most probably can return to diving. Decision making ability, ability to self rescue and rescue other divers residual disabilities that would limit ability to gear up and move in the water should be taken into consideration. Prospective divers should in all cases provide full disclosure to the dive instructor and certifying agency – bearing in mind the safety of buddies, dive instructors, divemasters and other individuals who are always affected by diving incidents.

AUTHOR

Ernest S. Campbell, M.D., FACS

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