Monday, October 24, 2005

Surgical Considerations Related to Diving

General Guidelines

A. Consider the illness or condition being operated upon and any relationship to the diving environment

B. 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.

C. 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.

D. Return to diving after surgery (See this web site under specific body system)
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].
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.
Pulmonary
Thoracotomy
Pulmonary System: 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.

Diving after Urinary Tract Surgery

---Should await clearance by the operating surgeon
---Post op wait depends on the type and extent of surgery done
---Surgical incisions should be completely healed without infection, drainage or herniation
---Ostomies and appliances should contain no air that cannot be vented
---All medications should be carefully evaluated for symptoms dangerous in the underwater environment
---All postoperative anemia should be corrected


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.