dive risks after nissen fundoplication for reflux

[searad]

During our last live aboard trip I developed spontaneous reflux of stomach contents uall the way up to my mouth. I underwent a complete work up to find out I had a
hiatal hernia and spontaneous reflux. Because of the risk of aspiration I underwent successful laparoscopic repair of my diaphragm & NissenFundoplication 2 weeks ago.
Since then I stumbled on the 1998 report of a young fit male diver who had a diaphragmatic and/or gastric rupture because of expanding gases in his stomach on ascent. Based on that single event the authors recommended against diving after a Nissen.
Besides that report, I have not been able to find any additional information regarding risks of diving or recommendations against diving after nissen fundoplication.
Does anyone know more about the risk of diving after a nissen fundoplication? Is there any evidence that pretreatment with Gas-X may help reduce the risks of intra-abdominal barotrauma? We are planning a 2 week trip to Bonaire 12 weeks after surgery. Any and all recommendations will be greatly appreciated! Thanks!

 

[Duke Dive Medicine]

Searad,

I forwarded the case report you're talking about to several well-known Duke physicians and unfortunately, there doesn't seem to be a hard and fast answer to your question. Dr. Theodore Pappas, one of our top GI surgeons, acknowledges that it's more difficult to burp after a Nissen fundoplication. He doesn't see a problem if an individual can produce a burp following a Nissen procedure, but recommends that diving "be done carefully" if an individual cannot burp. Dr. Richard Moon, the medical director of the Duke Center for Hyperbaric Medicine and Environmental Physiology, has heard of divers undergoing a partial "loosening" of their Nissen repairs. He cites several cases of gastric rupture following a dive and suspects that this would be more likely in someone who's undergone a Nissen, but he doesn't support "blanket disqualification for potential scuba divers who have had it done". Dr. Jake Freiberger, director of Duke Dive Medicine, doesn't believe that prohibition of diving is supported based on one case report and questions whether the subject of the report had complications prior to diving.

Your first source for recommendations should be the surgeon who performed your procedure. Of course, don't dive until he or she has cleared you for full activity. After that, if he or she does not have a problem with you diving, then I'd recommend following the old adage of "start low and go slow", especially on ascent. Don't consume gas-producing foods or beverages prior to diving, and ensure that you can burp if you need to.

Best regards,
DDM

 

[searad]

Thank you so much for all of your information and recommendations! I am glad to know there are no across-the-board red flags on diving after nissen surgery. This is such a common surgery, I would expect many horror stories if there would be a major contraindication to diving, not just one report from 1998. My surgeon is unaware of any diving precautions - but he is not a diver. Start low and go slow - plus shallow test dives and pretreatment with gas-x is my plan. Thank you again! Searad

 

[searad]

I want to thank all of you who shared your knowledge and opinion regarding diving after laparoscopic nissen fundoplication. At 13 weeks after surgery I went to Bonaire with my husband. Since my surgeon was more concerned with heavy lifting (risk of undoing the surgery) then barotrauma, my husband and dive masters staged me in and out of the water so I could avoid lifting the tanks, etc. We started "low and slow" but with no symptoms we advanced to deeper and drift dives. I never felt any pain or pressure in my stomach or esophagus. Never felt like I needed to burp (but can't of course). Not a single episode of reflux - which actually made breathing underwater a lot easier and more pleasant. No problems or complications at all. This of course does NOT mean that it is safe for everyone to dive after a nissen - they need to check with their own surgeons. But I am happy to add a tidbit of information to a topic that has not been fully explored for safety. I will report back if there is any change related to the surgery on future dives. Thanks again, I really appreciate your generosity in seeking opinions from the experts at Duke! Searad.

 

[Duke Dive Medicine]

Great news!! Continue to be just as vigilant as you were in Bonaire. Glad to hear that you had a positive outcome.

Best,
DDM

 

[fmcfish]

Searad
Any updates on further dive attempts after your Nissen? Are you able to dive or have you quit. I am considering having the surgery done in October and am planning a dive trip to st Lucia in January.
thanks

 

[DocVikingo]

Searad Any updates on further dive attempts after your Nissen? Are you able to dive or have you quit. I am considering having the surgery done in October and am planning a dive trip to st Lucia in January. thanks

Hi fmcfish,

A check of searad's board profile indicates that her last sign-in was on March 4, 2012. As such, you may wish to PM/email her.

Cheers,

DocVikingo