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Comprehensive information about diving and undersea medicine for the non-medical diver, the non-diving physician and the specialist. |
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Comprehensive information about diving and undersea medicine for the non-medical diver, the non-diving physician and the specialist. |
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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].
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
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.
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.
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