DAN Medical Frequently Asked Questions

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Bariatric Surgery and Diving

I am considering bariatric surgery. Is one method preferred over another for diving?

In recent years, more people have chosen
surgeries like gastric bypass or bariatric surgery
for weight loss and control. According
to the American Society of Bariatric Surgery,
in the late 1990s approximately 16,000
individuals underwent such surgeries. In
2003, more than 103,000 patients had
some form of bariatric surgery. Surgical
weight reductions, which are considered major operations, have inherent risks and
long-term implications. Because of this,
divers should know how these procedures
relate to diving.
The Roux-en-Y Gastric
Bypass Procedure:
The first procedure functions through
“malabsorption,” actually bypassing a
significant length of small intestine and
shortening the overall digestive tract. (Note:
most digestion takes place in the intestines
and not the stomach.) Shortening the
intestines reduces the amount of calories,
sugars and fat that would normally be
absorbed. This procedure allows patients
to eat more normal-sized meals and enjoy
a greater variety of foods. Because less food is absorbed, the patient loses weight.
However, some important nutrients, vitamins and other essentials may not be
absorbed either, particularly protein, fat,
fat-soluble vitamins (vitamins A, D, E and
K), iron, calcium and vitamin B12.
Patients can prevent deficiencies by taking appropriate supplements. This surgery
produces an aftereffect, a condition known
as the “dumping syndrome.” The stomach
and intestines move food along by a series
of wave-like contractions known as peristalsis.
Dumping syndrome occurs when stomach contents are rapidly emptied into
the jejunum, which is a part of the small
intestine between the duodenum and the
ileum. Resulting symptoms include rapid
heart rate, profuse sweating, decreased
attention span, abdominal pain / cramping,
dizziness, diarrhea and flushing.
These can occur from 30 minutes to three
hours after one eats. When someone
underwater suffers these symptoms, the
consequences can be dangerous. Doctors
recommend that any patient prone to
“dumping syndrome” not dive sooner than
three hours after eating.
A variation of the malabsorption procedure is the “duodenal switch,” in which a portion of the bypassed small intestine reconnects to the digestive tract at a different location. This still produces the same malabsorption type results. While it eliminates the dumping syndrome, it requires the same nutritional supplements and medical monitoring.
Adjustable Banded Gastroplasty or "Lap Band" isanother more restrictive procedure which reduces the size of the stomach. Following the surgery, the patient’s stomach may only hold 1-2 tablespoons in volume. This method drastically reduces the amount of food the patient can consume at any one time; digestion continues normally; and nutritional problems such as anemia and osteoporosisare almost nonexistent. The patient does not require as much ongoing medical supervision or dietary supplements.
Patients choosing this procedure must be
very selective about the food they eat: since absorption is not altered, any foods high in calories, sugars and fat will have the same affect on the body as they did before the surgery. If a patient consumes too much food or large pieces of food, vomiting can result.
After surgery, some patients experience
chronic acid reflux. Reflux and regurgitation of fluid and gastric liquid can present problems for a diver in the “head down” position, such as during descent. Divers can manage problems of regurgitation or vomiting through proper dietary considerations and possibly medications.
Gastrointestinal barotrauma presents
more dive-specific issues. During ascent,
gas pockets within the gastrointestinal
tract expand. If the gas is trapped due to
obstructed bowel, rupture could occur.
Dive physicians say divers who have had
uncomplicated bariatric surgery should not
be at any increased risk for gastrointestinal
barotrauma.
So, how soon after having bariatric surgery can you dive? Physicians recommend a four to six-week wait after major surgery before you resume strenuous activity. After bariatric surgery, it is probably best to wait longer, until you’ve made some appropriate eating adjustments, dealt with problems such as reflux and vomiting, and you’ve achieved your maximum weight loss. Usually this happens more than a year after surgery.
Divers should not resume diving until they can exercise safely. During any period of convalescence and inactivity, you can lose a significant amount of muscle mass and
strength. You should base your A safe return
to diving on requires recovery from any
therapy and a tolerance for all physical
activity that exceeds the reasonable demands
of diving - including the exceptional effort
that may be required when things do not
go quite as planned. and a resumption of
exercise that builds the appropriate response to the cardiac and pulmonary exertion you need to dive.
Because obesity is commonly associated with atherosclerosis, diabetes and hypertension, prospective divers who are obese or who have had bariatric surgery should be tested for these conditions and undergo specific exercise testing.