The great thing about the LAP-BAND® procedure is its versatility. Dr. Kirshenbaum can adjust the band to fit your individual needs and to maximize its weight-loss effects. You may need a band adjustment when:
- Your weight plateaus and everything else is truly the same.
- The same amount of food no longer satisfies your hunger.
Your First Adjustment
Your first adjustment is usually done four weeks after surgery. Kirshenbaum will discuss with you what size of band you have at your post-op appointment. We will also provide you with a post-op packet of information that will come with an identification card once you register your band online they will send you a permanent identification card.
How Much of a Fill Is Needed?
Every patient is different; there are different size stomachs and different amounts of fat surrounding each stomach. Just because one patient has a fill of 2.5cc and is losing weight at that level of fill does not mean that it is the magical number that will work for another.
How Many Fills to Get It Right?
Dr. Kirshenbaum’s approach is to add fluid until you have restriction and then back off by 0.1 ml. He does not limit any one fill to any specific amount. He wants you to have a effective fill every time you do a fill with him. It may require 3-4 fills before you’re actually at what we call the “sweet spot.” The body changes as the patient loses weight, so the fill volume that is right today may not be right after the patient has lost another ten pounds. In weight loss, everything gets thinner, including the stomach.
The right restriction is one that permits eating roughly a third of pre-surgery solid intake. A band that is too tight will not permit eating solids, and you will be forced to consume mushy foods and liquids which will not allow you to lose weight optimally.
The Days after the Fill
Once the fill has been performed, the band will be tighter. You will not feel it, of course. The urge to eat the same amounts at the same velocity will be there, but the ability to do so will not. Typically, due to inattention, you may ingest food that has not been chewed well enough. When this occurs, you will often experience PBing, or Productive Burping. This is not a burp, but a regurgitation of food that backs up into the mouth from the lower esophagus.
Scenarios: When a Fill May Not Be Needed
Reflux Symptoms
Reflux symptoms are caused by inflammation of the esophageal and/or stomach lining and usually occur after you have recently had an adjustment, or there has been an episode of food dislodging, PBing, and vomiting. Treatment for this is a self-imposed liquid diet. If the symptoms do not resolve or are clearly related to the fill, you must contact the doctor to arrange an unfill.
Band Tightens and Loosens During the Day
Typically, the band is tighter in the morning. Acid contact during the night can cause temporary thickening of the lining and, thus, greater restriction. Keep away from extremes such as very hot or very cold foods that can trigger esophageal spasm and further prevent you from eating an adequate breakfast. Some banded people cannot eat for a number of hours after rising, no matter if they drink hot liquids or not.
The fill is a vital part of band management and you need to be aware of the correct tightness at all times. Also, the fill is an essential part of the overall success of weight loss journey and need attention by your doctor to reach the goal you want to achieve.
Get all the facts on the LAP-BAND® adjustment process when you schedule your consultation at Lap Band Rockies in Denver.
Check back next week for our blog on LAP-BAND® pre- and post-adjustment instructions.
—Lindsey Kesel, Bariatric Consultant
