Lap Band Adjustments

Correct and sensitive adjustment of the band is imperative for weight loss and the long term success of the procedure. Adjustments (also called "fills") may be performed using an X-ray fluoroscope so that the radiologist may assess the placement of the band, the port and the tubing that runs between the port and the band. The patient is given a small cup of liquid that contains a radio-opaque fluid similar to barium - clear or white. When swallowed, the fluid is clearly shown on X-ray and is watched as it travels down the esophagus and through the restriction caused by the band. The radiologist is then able to see the level of restriction in the band and to assess if there are potential or developing issues of concern.

Do I need a fill?

A properly adjusted band should restrict your eating to about a third of your pre-surgical intake. If you can eat more than a third, you may need a fill. Remember, you must be eating only solid foods since the band is designed to restrict only solids. If you are eating mostly soft or liquid foods, we cannot evaluate the need for a fill since these foods will easily pass through the band even when properly restricted. After about a year, some patients find while they are eating only a third of their volume, selecting their food wisely and eating only solid foods, but still not loosing weight. This may also mean they require a small adjustment to "fine tune" their band to resume weight loss.

How much is right for me?

If everybody wore the same shoe size, then just one adjustment might also be right for everyone. The precise fill can only be determined for each individual at that moment in time. This means, if your fill volume (1 to 3 mls) results in the perfect restriction, this may not be the case several weeks or months later. A number of things determine the right fill such as your weight, (the more you weigh, the thicker your stomach is). As you lose weight and your stomach gets thinner, you may need a tighter adjustment. The adaptation of your esophagus and stomach also play a role in restriction. Sometimes when air is caught in your band (when your band is new), the amount of fill may vary after a couple of weeks. Thus the liquid does not seep out, but air will diminish the total fill volume.

What to expect

We perform fills under X-ray. This will permit us to visualize the size of the fill and the level of tightness produced when we inflate the band. We do this by accessing the port under the skin with a thin needle. This is a quick and painless procedure. Once the port is accessed, we ask the patient to swallow the liquid barium that shows up under x-ray. You will marvel at seeing how the barium goes down your esophagus and then stops at the band. You will then see how your upper pouch (new stomach) fills, pauses, then slowly goes through and pasted the band. We measure how long it takes the barium to pass, which is how we determine we have the correct tightness giving you the amount of restriction, necessary for weight loss. The whole procedure takes only a few minutes.

We will expect you to be on liquids for a couple of days in order for you and your body to get used to your new fill. Some people will try eating solid food while driving or flying back home, they will have food get stuck, then it becomes a medical emergency to remove liquid from the band. So after a fill, you must follow doctor's orders!

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