The Lap Band Adjustment Process

AKA “THE FILL PROCESS”

By M. Fistes with commentary from Dr. Ajay Goyal, FACS (in blue)

After my Lap Band surgery last October 2007, everything went very well . I went through the required liquid and soft-food post-surgical stages and carefully started eating some solid foods that were recommended by Dr. Goyal’s bariatric team.

I soon discovered that I was not having any problems eating just about any type of food. I learned from Dr. Goyal that this was because my Lap Band was in a fully-opened state. There were a few times that I had a little trouble swallowing larger chunks of well chewed foods, but not many. [Note from Dr. Goyal: When a Lap Band is placed in a patient it is always at a fully opened state because swelling from the surgery will act as a natural restriction for the first few weeks. After the initial swelling goes down, we begin the band tightening process after 4 weeks so that the band in secured in place.]

About four to six weeks after surgery, I arrived at Dr. Goyal’s office for my first adjustment (“fill”). After discussing how I was doing, Dr. Goyal had me lay down on the examination table. He easily found the small port under the surface of my skin to inject the saline to adjust the band. One small needle-pinch and I had my first adjustment. After the required 24 hours of Stage 1 soft foods following a fill, I started to carefully eat solid food again. I found that even after my first adjustment, I was not having any problem eating just about any food. It turns out that this is because the first fill is a small one to test my tolerance to the adjustment. I lost a little weight, but mostly from the liquid/ soft food diet right after the fill. [Note from Dr. Goya – Each patient tolerates a band adjustment differently – for some the first adjustment restricts the food to the level they’re comfortable with , for others they need a larger adjustment. However, we only fill the band to a set level and so some patients will require larger adjustments than others depending on if they are hungry or are not losing weight (see our band adjustment article). We always instruct our patients whose bands are either to tight or to loose to make an appointment as soon as they can so we can access the situation.]

I went back to Dr. Goyal’s office a month later for a check-up. After checking my progress and discussing my experiences after the first adjustment, we decided to move forward with another adjustment. So I received another small fill. It turns out that the adjustment process is not an exact science, it’s different for everyone. It is really a “feeling out” process to find that perfect condition where my food intake is minimized without any discomfort. I call it the Sweet Spot.

I noticed that after my second fill, I was starting to experience the Lap Band sensations that I had read about. I started eating smaller amounts of food and losing the weight. But, after several weeks went by I started feeling hungry again a short time after I would eat a meal. So, I was not at the Sweet Spot again. [Note from Dr. Goyal: As one loses weight, it’s normal to begin to feel hungry again, your body has gotten use to the smaller intake of food. This is why we have patients come in every four to six weeks for adjustments in the beginning.]

At the next monthly visit with Dr. Goyal we discussed my progress and decided to try another adjustment. This was a larger fill than previous adjustments, and I felt it right away. That’s because I had some trouble drinking the two cups of water that each patient must successfully drink after the adjustment to ensure a clear passageway to the stomach. So Dr. Goyal actually removed a small amount of saline from the Lap Band, and the problems went away.

That’s when I felt my progress improve dramatically! I was not eating nearly as much as I used to, and was losing quite a bit of weight. The Lap Band was really doing its job. At the next two month visit, Dr. Goyal was very happy with my progress and no adjustments were necessary. But…

The weight loss leveled off. I was beginning to feel a little hungry again soon after some meals. Some foods seem to bypass the band directly, while others follow the more standard, slow digestion process. I thought I might need another adjustment, because I was not feeling the “band effect” like I was after the previous adjustment. At the next visit, Dr. Goyal explained several things:

1. The stomach area can shrink slightly as you lose weight causing the band to loosen [Dr. Goyal: Think of the band as a belt, as you lose weight your waist gets smaller but the size of the belt stays the same, causing the belt to feel loose.] A “fill” can fix the problem.

2. If I got another adjustment, I would be more limited in what foods I could eat.

3. In tandem with the Lap Band adjustments, it’s important to step-up the exercise program for weight is lost to continue and to reach my ultimate goal.

I’m constantly working to find my Sweet Spot. But I’m still losing weight. My goal is 100 pounds, and I’m currently at 73, so I’m doing well and getting close. I think I may request one more small fill sometime soon, but will discuss this in detail with Dr. Goyal before making a final decision. I’m still being very careful to choose the right foods and to chew everything I eat thoroughly. Luckily, I’ve never had a regurgitation problem that I’ve heard and read that others have had. I guess slow and steady really does win the race – luckily I’m patient.

[Note from Dr. Goyal: Weight loss from the Lap Band is a slower process and requires a more disciplined approach to eating and nutrition post-surgery than from gastric bypass surgery. Gastric bypass surgery restricts your food intake like gastric band surgery, however it also involves malabsorption of food which increases weight loss. Therefore, you will not lose weight at the same rate as a gastric bypass patient.]