Howdy Ed:
Sorry to hear about your trouble. I'm not aware of any research looking at hematomas and diving, but I've never heard of hematomas being a specific contraindication to diving. A person with an acute hematoma (just happened) would need to avoid
any particularly strenuous activity because straining could potentially lead to further bleeding and expansion of the hematoma. But once a hematoma has organized (and it would almost certainly be organized at 8 weeks) activity is only limited by symptoms. ("Doc, it hurts when I do this." "Don't do that.")
In decompression I would think that an organized hematoma would act as any other poorly vascularized scar from surgery. There might be a slight theoretical increased risk of localized DCS in the lesion, but not an overall increased risk of a decompression illness for the diver. Surgical scars are not considered a reason to stop diving, and I wouldn't know why an organized hematoma would be different- whether it be recreational or commercial diving.
As DocV said, hematoma formation can occur with any operation. The problems you describe are not unheard of with laparoscopic hernia surgery and do not necessarily indicate that anything was done "wrong". Hematomas will usually resolve on their own without further intervention, but they'll do it when they darn well please. Different people heal differently. IMHO, they should be addressed surgically only when they're continuing to expand (ongoing bleeding), they become infected, or the surrounding tissues are being compromised (e.g. losing blood supply) because of the pressure. Otherwise they should be left alone to resolve on their own. Sometimes a hematoma will liquify and the blood can be drawn out with a needle to help it resolve faster. FWIW, people will always develop a "knot" of scar tissue that they can feel in a surgical incision- that's your body plugging the hole. In most people it will eventually go away as the scar matures. But usually that "normal" knot is no bigger than the incision.
Now I'm gonna jump up on my soapbox for a minute for the benefit (I hope) of other readers who might one day need hernia surgery. The following is just my 2¢ from anecdotal experience and not scientific research. The laparoscopic hernia operation is a
fine procedure in the hands of an expert surgeon, but IMHO it's primary utility is in marketing. Patients like to be able to go to cocktail parties and say they had the "laser" surgery they saw on The Discovery Channel. In the hands of the typical community surgeon, the laparoscopic hernia repair has a higher recurrence rate, a higher (and potentially more devastating) complication rate, and a higher cost than other types of hernia repair. Those trouble rates are still
acceptably low, but higher than with more "traditional" surgery.
I was trained in laparoscopic hernia repairs and I do lots of laparoscopic surgery but I don't fix hernias laparoscopically. Most of the surgeons in my area who started doing laparoscopic hernia repairs have all but abandoned the procedure. I would hope that surgeons who
do perform the laparoscopic repair would honestly discuss the relative risks and benefits of various types of hernia surgery and avoid the "gee whiz" factor of laser surgery. As far as using mesh with a hernia repair is concerned, the presence any foreign body can increase the risk of infection, but the body does not "reject" modern prosthetic mesh except perhaps in very
rare instances. (I've not seen it in 18 years, and general surgeons see
lots of hernias.) While some patients can have problems with infection, overall the use of mesh
reduces the chance of problems with groin hernia surgery. The use of mesh can reduce the risk of recurrent hernia by 10 fold.
As Dr. Reinertson said, as soon as the wounds have healed satisfactorily, the patient has been released to lift and strain, and residual symptoms allow, people can return to diving after hernia surgery. I would not consider the mere presence of 8 week old hematomas to be a specific contraindication to diving.
You can read what DAN has to say about inguinal (groin) hernias and diving at:
http://www.diversalertnetwork.org/medical/faq/faq.asp?faqid=48
You can look at what Scubadoc has to say at:
http://scuba-doc.com/hernia.htm
HTH,
Bill
The above information is provided for discussion purposes only and is not meant as specific medical advice for any individual.
