kbattal

The following site is a good source for information for a nurse or a doctor to do fills correctly. I had to do it myself but I was forced to. For information purposes only. There are 15 pages. http://lapbandtransformation.com/adj1.htm You might also try to put 5 fingers of your less dominant hand around the port, feel it, as the patient bends, you will find the port better, press your fingers around the port in circle, you will feel the circular quarter shape, just about a quarter size, level it, so that with your right hand you can insert a noncore needle in the midlle of the septrum perpendicularly, insert till you hit the metal part of the port, just about an inch, do not use force, VG bands are low pressure ports, inject the saline with little force. For 4cc bands you might need a little more force because they are under pressure,use much less saline as the doc instructs. The Needle is for single use, properly dispose it. Disclaimer: For nurse and praticiners education only, patients need to know what professional do, isometime they mess up, and quite often poke around a lot.

The first 40 pounds were very easy, the next 20 pounds were difficult, the last 20 pounds are extremely difficult.

This explains it. The bottom part of the syringe was blue, then I believed mistakingly the color of the contrast agent was also blue. Anwyay, it was clearly visible under the fluoro.

Dr C, I was also worried of a possible leak a month ago. The doc injected 1cc contrast agent omnipaque (blue color) and 1cc saline, to make it total of 7.0cc in the band. Then I went to another fill doctor two weeks ago, he draw the saline 6cc but no omnipaque, the Fluid was clear, 1cc less, and there was no blue color mixed up. I assume the omnipaque was still in the band, he got misreading. Since it is thicker, omnipaque does not mix with saline, and can not be drawn. This is my conclusion. Is that right. I really had 7cc in the band not 6cc. Under fluoro, I was able to monitor how the blue stuff (contrast agent) went through the tube up to the band. The other doctor could not draw it up. Is this normal? Thanks Dorin

Your body and your eating habits may need time for a good restriction. You just need to learn to eat small bites and chew well, it takes time. At my 4th fill I am still strugling to chew well. I feel quite restricted, that means, if I eat half a cup of solid food, chewed well, I feel satisfied, and it lasts minimum 3-4 hours.

As far as I remember, I never saw any referencess to different tube sizes, and how much a tube holds. There are two different ports, one for the vanguard, and the other for the 4ccs.

Dear Bawillims1, It souds like 1- you have a larger band, or 2- your port or tube is leaking, 3- I also read in the past threads that rebanded bandsters need more saline to fill good restriction. Maybe you need to max it out. I have a very agressive and good fill doctor now. The last time I asked him to draw all the saline to see how much was in there. There was about 6cc saline, then he put back in there. The needle back in the place, he max out my band, I asked him to do this, he could only fill in an extra 6cc. No more. I think I had total 12cc in that time. I was out the same day for about 4 hours, to feel how it felt like. I felt miserable, I could not even drink Water, so the same day he took 4cc out, I could hardly drink water, but no Soups. The next day My swelling went away, and I could only drink Soup. The third day I could eat mushy stuff, and after two weeks, now, I feel quite restricted. As long as I chew well, I can tolerate most solid foods. So in your case, I would ask him to draw the saline first to see how much was there, and then try with a larger dose, like an extra 4cc to fill in, maybe you have a larger band. This way you could be sure, if there were any leaks or you have a larger or smaller band. 4cc bands are high pressure bands, once the needle is in, some saline comes up to syringe, you could see it. 10cc bands are low pressure, usually no saline comes up at 4cc. I bet you did not look at the syringe anyway.

The Health and Nutrition Editor from the Associated Press, Marilynn Marchione, wrote a clever article about some of the ideas in Mindless Eating. If you missed it, here it is: 12 Ideas to Keep Off Holiday Pounds By Marilynn Marchione, Associated Press Medical Writer Three French pastries ... two turtle cheesecakes ... and a partridge in a pear sauce. The Twelve Days of Christmas bring holiday foods meant to be enjoyed, but no one wants a weight problem when the merriment ends. food psychologist Brian Wansink has spent many of his own days researching how these problems occur. His new book, "Mindless Eating: Why We Eat More Than We Think" explores the unconscious cues that make us feast as we do, and how we can keep them from manipulating us. Nearly all of his suggestions are based on published results of scientific studies he has conducted as director of Cornell University's Food and Brand Lab. Here are 12 of his tips, one for each day of the season: _ Put high-calorie foods on plates in the kitchen and leave leftovers there. You'll eat 15 percent to 20 percent less. Do not serve "fat-family" style (from a big platter or bowl that is passed) unless it's veggies or salad. _ See it before you eat it. Dishing out Chex Mix led one group to consume 134 fewer calories than others who ate straight from the bag. _ Keep the evidence on the table _ turkey bones, muffin papers, candy wrappers. Diners in one study ate 30 percent more chicken wings when the bones were periodically cleared away than others whose bones stayed in front of them. _ Bank calories. Skip the appetizers if you know you want dessert. You also will be more accurate at estimating how many calories you consume. _ Sit next to the slowest eater at the table and use that person to pace yourself. Always be the last one to start eating, and set your fork down after every bite. _ Embrace comfort food. Don't avoid the food you really want, but have it in a smaller portion. _ Avoid having too many foods on the table. The more variety, the more people will eat. People ate 85 percent more M&Ms when they were offered in nine colors rather than seven. _ Keep your distance. To reduce the mindless snatch and grab, move more than arms length away from the buffet tables and snack bowls. _ For foods that are not good for you, think "back." Put them in the back of the cupboard, the back of the refrigerator, the back of the freezer. Keep them wrapped in aluminum foil. Office workers ate 23 percent less candy when it was in a white, covered candy dish than in a see-through one. _ Use small bowls. A study found that people serving themselves from smaller bowls ate 59 percent less. _ Use tall, narrow glasses for drinks. Even experienced bartenders poured more into short, squat glasses than into skinny ones. _ Don't multitask. People tend to unconsciously consume more when distracted by conversation or a game on TV. Setting your fork down and giving the conversation your full attention will prevent overeating. "We don't know exactly how many calories, but chances are you'll enjoy it more," Wansink said. "And people will enjoy you more."

I am no longer bringing it up. After my third fill, the doc did under fluoro, I am properly restricted now. I just feel like I do not need another fill at least another 3 months. But I can tolerate many foods as long as I can chew well, and eat slowly, and can not eat food more than the size of one half of an apple, and then my hunger goes away. I have 45 pounds more to lose the get below 25 BMI, so really I am done with fills, at least I hope so.

Quick update on my VG band. After numerous attempts, the my doc accepted my fill request. We checked the system under radiology, everything looked fine. Initially barium was going down too fast, after 2cc injection , it flowed rather slowly. There was no leak on the port, my self fill attempt was probably good, I feel good restricted now. I almost lost 4 pounds in 4-5 days, 40 pounds in 3 months. I can hardly eat one orange, or half an apple at a time. I feel quite satisfied. I didnt tell him that I self filled 2.5 cc. He said I should come back after 6 months for another adjustment. I did not argue with him, I tipped him 100 euros. He is not supposed to take money from patients, but the system is differnet here. You will never understand it, because you never lived through a communist era. Outside USA, the doctors are less supervised by Inamed, and I do not think they are properly educated about adjustments with regard to VG bands. He says 2cc is atmost he can fill in the first 6months, just nonsense. I am not even sure if he used a fresh huber needle for me, because he never unwrapped it in front of me, it was in his hand already, and there was another patient before me he had to fill a couple minutes ago.I suspect he used the same needle. I just did no ask about it, because I did not want him to be angry with me. I just liked to see how saline went through the tube on the monitor (there was some omnipaque in it). Pouch size, and location of the band looked OK. Some of you do not know how well doctors are educated in USA, and how much they are afraid of lawyers, you pay tons of money for a simple operation because your team is excellent, they need to be. Asmall mistake costs them dearly, whereas here in Romania, you get almost nothing, just headache. In USA You do not have to worry about anything. You are well taken care by professional staff. Here in Romania things are quite different. Most health care is free, but quite poor. Doctors and health care personel is poorly educated,and underpaid. The assistant doctor told me most complication patents have are port infections. How come that is possible, if they are using sterile procedures,and single use needles. You guys are too spoiled. Dorin.

Well, first of all I am very happy that I am banded, and lost 40 pounds in three months. I recommend it everyone, there are risks, hepatisitis etc, in everyday life, but people seem to keep up with these things, conditions are improving rapidly. I still like my doctor, he is at least better than most of the rest. This is part of the life. Dorin

I am just angry because most of you believe that health care standards are same in other countries. Doctors and health personel are well educated, courteous, helpfull. Just no. Here in Romania, Health care system is under state control, and free, but docs are just like ordinary government employees. Just like a post office clerk. They do not get post education. State health care is free, but you have to wait in lines to get basic care. Basically, state health care system is in ruins. Staff and doctors are in general undereducated, old , underpaid, the hospitals and equipments are old, and dirty.Corruption is going everywhere. Good doctors and health care personel move to other european countries. My doc is the chief of the surgery unit, but he does not have an office of his own. We always talk in corridors,there are maybe 10 doctors packed up in one single room. They are like an ordinary government employee. How can you expect good health care from them. I have done the surgery there, because the doc is the most experienced in this field in Romania.He has done over200 lapbands. but his staff is terrible, and unprofessional. No pre-post information. You are mostly on your own. He gets his big money from patients (he is a public employee) after the surgery, five hundred dollars in packet, never wants to get bothered after that. So I had to keep up with his ego. He just doent like too many fills. He told me I should come after 6 months, how can I argue with him. I should wait another 6 months for the next fill, for a super sized VG band. This is unethical, unprofessional, and irresponsible behaviour on his part. I am pretty sure he use the same needle for many fills, because the state doesnt pay for the huber needle, they do not have a budget for that. He just asked extra money for that. I know there are some private clinics doing the same procedure, but I do not believe the docs are as well experienced. The hospital had the fluoro unit,thanks god, I could check the health of the system. I have seen the contrast agent (omnipaque) flowing, through the tube to the band. I was really happy because I was also worried that when I did my own fill, I could puncture my port because I used some force to inject that I needn't to, and used a core needle. Anyway, next time I will bother him a lot so that he will accept another fill, I hope so. Money might talk.:mad: Dorin

There is a good article below, looks like if someone does not lose weight, it is not her or his fault totally. Why Did They Lose More Weight Than Me?” - by Cynthia K. Buffington, Ph.D. During a recent support group meeting, five patients whose surgical procedures were identical and performed on the same day asked why they were losing weight at different rates. Three months following laparoscopic adjustable gastric banding, the only male patient, Charles, had lost 71 pounds. Sarah, on the other hand, had lost 57 pounds, Sally had lost 40 pounds, Sue was 29 pounds lighter, and Jennifer had lost only 19 pounds. Why had Charles lost more weight than the female patients? Why had Sue and Jennifer experienced less weight loss than the other patients? Were Jennifer and Sue not adhering to the recommended postoperative dietary protocol? Were they consuming calorie-dense beverages or foods, such as milkshakes, colas, cake, ice cream? Did Charles and Sarah, who lost the greatest amounts of weight, exercise more regularly than Sally, Sue, and Jennifer? In order to determine why there were such large differences in weight loss between patients, we examined the lab results, nutritional profiles, and clinical reports of their most recent follow-up appointments, which had taken place only 3 and 4 days earlier. To attempt to understand why some individuals lost more weight than others, we first examined body size measurements before and after surgery. All patients had a somewhat similar body mass index (BMI) prior to surgery, i.e. range 43 to 47, but patients differed as to where on their bodies fat was distributed. Body fat distribution is determined by measuring the circumference (distance around) the waist and the circumference of the hips and then dividing the waist circumference by that of the hips to derive the waist-to-hip ratio (WHR). A male with a WHR greater than 0.95 stores much of his body fat around the waist (abdominal fat). Premenopausal females store fat in their hips and buttocks and generally have a WHR less than 0.80, but females with a WHR greater than 0.80 tend to store fat in abdominal regions, as well. Deep abdominal or visceral fat has a much faster rate of turnover than fat that is deposited on the hips and thighs. For this reason, larger amounts of abdominal visceral fat are lost with calorie restriction than are fat deposits on the hips and thighs. A person with abdominal obesity, therefore, is likely to lose weight more rapidly on a diet or after surgery than would someone with fat on the hips and thighs. Men tend to store much larger amounts of fat in abdominal visceral adipose depots than females and, for this reason, men are generally able to lose weight more rapidly than females. Charles had a pre-surgery WHR of 1.2 and at 3 months had lost most of his weight from around his waist. The greater rate of turnover of Charles’ abdominal fat is likely to be one of the primary reasons he was capable of losing more weight than the female patients. Sarah, Sally and Sue all had similar WHR, i.e. 0.85, 0.84, and 0.83, respectively. Changes in waist and hip circumferences at 3 months after surgery were also similar, with all patients having a proportionately greater loss of inches from the waist than from the hips and thighs. Jennifer who had lost the least amount of weight of any of the patients (only 19 pounds) had very large hips and thighs and a relatively small waistline and upper torso. Her WHR before surgery was 0.68. Fat on the hips and thighs is broken down at a far slower rate than fat in abdominal regions. Women who have large hips and thighs and small waists generally have the greatest difficulty losing weight following surgery or with any other anti-obesity procedure. Jennifer may, therefore, have lost the least amount of weight post-surgery because most of her fat was stored on her hips and thighs where fat turnover is slow. Differences in fat distribution could not explain why Sarah, Sally and Sue’s weight losses differed, as all three had a similar WHR. (Remember: Sarah had lost 57 pounds, Sally 40 pounds, and Sue only 29 pounds.) The three females also had similar starting weights. Furthermore, exercise habits could not account for differences in these patient’s postoperative weight losses, as all three patients were participants of the same postoperative exercise program. Nutritional profiles, however, did provide a clue as to why Sue’s weight loss post-surgery differed from Sarah and Sally. At our clinic, nutritional profiles are obtained from patients’ food diaries at each of their follow-up visits. Nutritional information obtained from these profiles include total calorie intake, the percentage of diet that is Protein, carbohydrate and fat, the types of protein, carbohydrate and fat consumed, and dietary Vitamins and minerals. We found that Sarah and Sally’s nutritional profiles were similar with regard to daily calorie intake and dietary composition. Sue’s diet, however, significantly differed. Sue was eating an average of 250 calories more per day than Sarah and Sally. In addition, Sue was consuming fewer calories as protein and more calories high in sugar-containing carbohydrate. Sue’s greater intake of sugar-containing carbohydrate, coupled with the slightly greater number of calories she was consuming each day, could have contributed to the lower weight loss she experienced when compared to the weight losses of Sarah and Sally. Sugar-containing carbohydrate and processed grains increase insulin to levels higher than would occur if fiber-rich carbohydrates were consumed, such as fruits, whole grains, nuts, legumes, vegetables. Insulin, in turn, drives fat into fat storage depots and reduces the breakdown of fat, thereby adversely affecting weight loss success. Sue’s diet was not only higher in simple carbohydrates but was also lower in protein than the diets of Sarah and Sally. Eating sufficient amounts of protein helps prevent the breakdown of muscle and other lean body tissue that may occur post-surgery or with low calorie diets. Muscle has high metabolic activity and oxidizes (burns) fat. A loss of muscle or other lean body tissue, therefore, would reduce metabolic activity and fat metabolism. Over the 3-month postoperative period, Sue lost proportionately more muscle and other lean body tissue and proportionately less fat than did Sarah or Sally. (Note: body composition was measured by bioelectric impedance). Sue also had a greater reduction in basal metabolic activity (measured by indirect calorimetry) in association with her loss of muscle and lean body tissue. Basal (resting) metabolic activity accounts for up to 70% of all calories burned during the course of the day. Sue’s failure to lose weight as effectively as Sarah and Sally, therefore, could have resulted, in part, from her postoperative loss of lean body tissue and decreased basal metabolic rate. Sue’s poor nutritional profile, her greater muscle and lean body tissue loss with surgery and reduced basal metabolic activity could explain why she lost less weight than did Sarah or Sally. However, differences in nutritional profiles, body composition, and basal metabolic activity, as well as fat distribution, initial body size, and levels of physical activity do not explain why Sally lost less weight with surgery (17 pounds less) than did Sarah, since all of these measures were similar. Why, then, would Sally have lost less weight than Sarah? According to Sally’s 3-month postoperative clinical records, she was still taking diabetes medication (a sulfonylurea) to control her blood sugar, albeit at a lesser dosage than before surgery. She was also taking a beta-blocker for hypertension. Sarah, on the other hand, was on no medication. Ironically, many medications used to treat diseases caused or worsened by obesity increase body weight. Most diabetes medications (except metformin) cause fat accumulation and weight gain, including insulin, sulfonylureas and the thiazolidinediones. Many anti-depression medications or mood stabilizers also cause weight gain, especially lithium and the tricyclic antidepressants. In addition, steroids used to treat osteoarthritis or autoimmume disorders increase body weight and fat accumulation, as do beta-blockers and Calcium channel blockers for hypertension. It is likely that Sally’s diabetes and hypertension medications were responsible for her inability to lose as much weight as Sarah. However, there could have been factors other than medication, diet, exercise, metabolic rates, or fat turnover that caused post-operative differences between Sally’s or Sarah’s weight losses or those of other patients in the group. One patient may have lost less weight than another because their growth hormone levels were low, sex hormone production was altered, or cortisol levels were high. Defects in hormones, gut factors or neurochemicals that regulate food intake, satiety and energy expenditure may also have caused variability in patient post-surgical weight loss. Altered activities of enzymes regulating fat metabolism or energy utilization may have influenced rates of post-surgical weight loss. Genetics could have contributed to weight changes, as could numerous other conditions that influence energy intake or expenditure. Why, then, does one patient lose more weight than another with surgery? For numerous reasons, including differences in calorie intake, energy expenditure, body habitus and body composition, basal metabolic activity, hormone profiles, genetics and much more. Because weight loss is regulated by such a myriad of factors, it would be highly unlikely that any two individuals would lose identical amounts of weight post-surgery, even if they were consuming the same amount of calories and performing similar amounts of physical activity. Therefore, it is important that healthcare professionals realize that identical surgical procedures do not result in identical weight loss patterns and that weight reduction is regulated by far more than calories in and calories out. Furthermore, patients should not despair or feel unsuccessful if they have lost less weight than others, particularly if they have been honest in adhering to their postoperative dietary and exercise regimens. Cynthia Buffington is the Director of Research, U.S. Bariatric, Fort Lauderdale, Miami, Orlando Originally Published in Beyond Change - 2004

I hope this is a right place to ask. I am banded 3 months ago, and lost 40 pounds,for about two weeks I am experiencing an increase in libido, and sexual activity, almost every morning, my wife is quite happy about it. I am 44, definetily I see an improvement in our sexual relationship, my wife is much younger than me, this has been a good suprise for me, If anybody have similar opinions, please let us know. Dorin

I have a large Vanguard band, 11cm, and can hold up to 13cc. I live now abroad. I have 2cc already, but I still can eat 2 whopper burgers without any problem at a time. I am constanly on regime, and still can not lose weight. I feel like my stema is wide open. Filling is easy, mostly nurses and assistants do it. Mine was done by the doctor. He lies you on the table, he carefully senses where the port is, and enters the needle to the port under the skin, till it hits the metal plate, and draws the saline to see how much there, and change the saline rezervoir in the injector with the new saline, and carefully injects the saline in. Everything lasts less than 5 min. I can easly sense where the port is. Zero mistake, and can locate the middle of the port, no problem. I am used to injection. So what are the risk. I know my needle is not allegran made, I believe my doctor also used an ordinary needle. What do you guys think.

I was also allowed to keep my underwear during the operation, but a couple of nurses looked inside what I had down there unshamefully. I was half awake, was just getting narcoz (spell). One of the same nurses took care of me well after the operation, she was always around me. She kept a smile on my face, I forgot about the pain thinking about her. I had the surgery in Romania, what they did is not quite normal around here,but again the personel is not very professional. She was really cute though, I was not emberessed (spell??), but was pleased to tell you the truth.

You are welcome. There are other great articles. http://www.ajronline.org/cgi/reprint/170/4/993?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Gastric+Banding+&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT http://www.ajronline.org/cgi/content/full/184/1/109?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Gastric+Banding+&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

The radiologist plays a key role in the early detection of complications and treatment of specific abnormalities. The following is an article which is submitted to FDA fro swedish band. There are numerous pictures to give you an idea for early detection of abnormalities. http://www.ajronline.org/cgi/content/full/177/1/77

Yes, I arranged an adjustment with my doctor . Finally I was able to change his mind. I complanained that I gained 3 kgs last month , that i was able to eat as much as I do (i had to exegerate). We did a complete check-up for my system under fluoro and checked if there were any leaks too. He used omnipaque as the contast agent. Becuase he mainly uses swedish band, he does not fill more than 2cc in the first six month, quite qontrary to Inameds instructions, but he made exception for me. I saw there was no leak because the contrast agent was clearly seen in the tube under fluoro. He injected total 2cc. I feel a little more restriction now,but is not quite as much as I wanted it to be. He said too much restriction might cause pouch dilation. Dorin

These are from the Inamed's own patient booklet. I always read about warnings, side effects before taking any any medicine. Most of them are useful for pre-and post op. patients. If you want to find the advantages, go to their site. I can only say, I am pretty happy that I have the band, it works, and I would like to it keep as long as i can. http://www.allerganandinamed.com/pdf/health/94163_04_LB_Product_Data_Sheet.pdf http://www.allerganandinamed.com/products/obesity/us/patient/patient.html http://www.allerganandinamed.com/products/obesity/us/clinician/clinician.html http://www.allerganandinamed.com/pdf/health/94829-12_LB_Patient_Book.pdf

Taken from http://www.fda.gov/cdrh/pdf/P000008b.doc WARNING: Laparoscopic or laparotomic placement of the LAP-BAND System is major surgery and death can occur WARNING: Failure to secure the band properly may result in its subsequent displacement and necessitate reoperation. WARNING: A large hiatal hernia may prevent accurate positioning of the device. Placement of the band should be considered on a case-by-case basis depending on the severity of the hernia. WARNING: The band should not be sutured to the stomach. Suturing the band directly to the stomach may result in erosion. WARNING: Patients’ emotional and psychological stability should be evaluated prior to surgery. Gastric banding may be determined to be inappropriate, in the opinion of the surgeon, for select patients. WARNING: Patients should be advised that the LAP-BAND System is a long-term implant. Explant and replacement surgery may be indicated at any time. Medical management of adverse reactions may include explantation. Revision surgery for explantation and replacement may also be indicated to achieve patient satisfaction. WARNING: Esophageal distension or dilatation has been reported to result from stoma obstruction due to over-restriction, due to excessive band inflation. Patients should not expect to lose weight as fast as gastric bypass patients, and band inflation should proceed in small increments. Deflation of the band is recommended if esophageal dilatation develops. WARNING: Some types of esophageal dysmotility may result in inadequate weight loss or may result in esophageal dilatation when the band is inflated and require removal of the band. On the basis of each patient's medical history and symptoms, surgeons should determine whether esophageal motility function studies are necessary. If these studies indicate that the patient has esophageal dysmotility, the increased risks associated with band placement must be considered. WARNING: Patients with Barrett's esophagus may have problems associated with their esophageal pathology that could compromise their post-surgical course. Use of the band in these patients should be considered on the basis of each patient’s medical history and severity of symptoms. WARNING: Patient self-adjustment of superficially placed access ports has been reported. This can result in inappropriate band tightness, infection and other complications. Precautions CAUTION: Laparoscopic band placement is an advanced laparoscopic procedure. Surgeons planning laparoscopic placement must: Have extensive advanced laparoscopic experience, i.e., fundoplications. Have previous experience in treating obese patients and have the staff and commitment to comply with the long-term follow-up requirements of obesity procedures. Participate in a training program for the LAP-BAND System authorized by BioEnterics Corporation or an authorized BioEnterics distributor (this is a requirement for use). Be observed by qualified personnel during their first band placements. Have the equipment and experience necessary to complete the procedure via laparotomy, if required. Be willing to report the results of their experience to further improve the surgical treatment of severe obesity. CAUTION: It is the responsibility of the surgeon to advise the patient of the known risks and complications associated with the surgical procedure and implant. CAUTION: As with other gastroplasty surgeries, particular care must be taken during dissection and during implantation of the device to avoid damage to the gastrointestinal tract. Any damage to the stomach during the procedure may result in erosion of the device into the GI tract. CAUTION: During insertion of the calibration tube, care must be taken to prevent perforation of the esophagus or stomach. CAUTION: In revision procedures the existing staple line may need to be partially disrupted to avoid having a second point of obstruction below the band. As with any revision procedure, the possibility of complications such as erosion and infection is increased. Any damage to the stomach during the procedure may result in peritonitis and death, or in late erosion of the device into the GI tract. CAUTION: Care must be taken to place the access port in a stable position away from areas that may be affected by significant weight loss, physical activity, or subsequent surgery. Failure to do so may result in the inability to perform percutaneous band adjustments. CAUTION: Care must be taken during band adjustment to avoid puncturing the tubing which connects the access port and band, as this will cause leakage and deflation of the inflatable section. CAUTION: The LAP-BAND System is for single use only. Do not use a band, access port, needle or calibration tube which appears damaged (cut, torn, etc.) in any way. Do not use one of them if the package has been opened or damaged, or if there is any evidence of tampering. If packaging has been damaged, the product may not be sterile and may cause an infection. Do not attempt to clean, re-sterilize or re-use any part of the LAP-BAND Adjustable Gastric Banding System. The product may be damaged or distorted if re-sterilized. CAUTION: It is important that special care be used when handling the device because contaminants such as lint, fingerprints and talc may lead to a foreign body reaction. CAUTION: Care must be taken to avoid damaging the band, its inflatable section or tubing, the access port or the calibration tube. Use only rubber-shod clamps to clamp tubing. CAUTION: The band, access port and calibration tube may be damaged by sharp objects and manipulation with instruments. A damaged device must not be implanted. For this reason, a stand-by device should be available at the time of surgery. CAUTION: Failure to use the tubing end plug during placement of the band may result in damage to the band tubing during band placement. CAUTION: Do not push the tip of any instrument against the stomach wall or use excessive electrocautery. Stomach perforation or damage may result. Stomach perforation may result in peritonitis and death. CAUTION: Over-dissection of the stomach during placement may result in slippage or erosion of the band and require reoperation. CAUTION: Failure to use an appropriate atraumatic instrument such as the LAP-BAND Closure Tool to lock the band may result in damage to the band or injury to surrounding tissues. CAUTION: The band is not intended to be opened laparoscopically with surgical instruments. Unrecognized damage to the band may result in subsequent breakage or failure of the device. CAUTION: When adjusting band volume take care to ensure that the radiographic screen is perpendicular to the needle shaft (the needle will appear as a dot on the screen). This will facilitate adjustment of needle position as needed while moving through the tissue to the port. CAUTION: When adjusting band volume use of an inappropriate needle may cause access port leakage and require re-operation to replace the port. Use only LAP-BAND System Access Port Needles. Do not use standard hypodermic needles, as these may cause leaks. CAUTION: When adjusting band volume never enter the access port with a “syringeless ” needle. The Fluid in the device is under pressure and will be released through the needle. CAUTION: When adjusting band volume once the septum is punctured, do not tilt or rock the needle, as this may cause fluid leakage or damage to the septum. CAUTION: When adjusting band volume if fluid has been added to decrease the stoma size, it is important to establish, before discharge, that the stoma is not too small. Care must be taken during band adjustments not to add too much saline, thereby closing the gastric stoma. Check the adjustment by having the patient drink Water. If the patient is unable to swallow, remove some fluid from the port, then recheck. A physician familiar with the adjustment procedure must be available for several days post-adjustment to deflate the band in case of an obstruction. CAUTION: It is the responsibility of the surgeon to advise the patient of the dietary restrictions which follow this procedure and to provide diet and behavior modification support. Failure to adhere to the dietary restrictions may result in obstruction and/or failure to lose weight. CAUTION: Patients must be carefully counseled on the need for proper dietary habits. They should be evaluated for nutritional (including caloric) needs and advised on the proper diet selection. If necessary to avoid any nutritional deficiencies, the physician may choose to prescribe appropriate dietary supplements. The appropriate physical monitoring and dietary counseling should take place regularly. CAUTION: Patients must be cautioned to chew their food thoroughly. Patients with dentures must be cautioned to be particularly careful to cut their food into small pieces. Failure to follow these precautions may result in vomiting, stomal irritation and edema, possibly even obstruction. CAUTION: Patients must be seen regularly during periods of rapid weight loss for signs of malnutrition, anemia or other related complications. CAUTION: Anti-inflammatory agents, which may irritate the stomach, such as aspirin and non-steroidal anti-inflammatory drugs, should be used with caution. The use of such medications may be associated with an increased risk of erosion. CAUTION: Patients who become pregnant or severely ill, or who require more extensive nutrition, may require deflation of their bands. CAUTION: All patients should have their reproductive areas shielded during radiography. CAUTION: Insufficient weight loss may be caused by pouch enlargement or more infrequently band erosion, in which case further inflation of the band would not be appropriate. CAUTION: Elevated homocysteine levels have been found in patients actively losing weight after obesity surgery. Supplemental folate and Vitamin B12 may be necessary to maintain normal homocysteine levels. Elevated homocysteine levels may increase cardiovascular risk and the risk of neural tube abnormalities. CAUTION: Although there have been no reports of autoimmune disease with the use of the LAP-BAND System autoimmune diseases, connective tissue disorders (i.e., systemic lupus erythematosus, scleroderma) have been reported following long-term implantation of other silicone devices. These conditions have primarily been hypothesized to be associated with silicone breast implants. There is currently no conclusive clinical evidence to substantiate a relationship between connective-tissue disorders and silicone implants. Definitive long-term epidemiological studies to further evaluate this possible association are currently underway. However, the surgeon should be aware that if autoimmune symptoms develop following implantation, definitive treatment and/or band removal may be indicated. Likewise, patients who exhibit preexisting autoimmune symptoms should be carefully evaluated prior to implantation of the LAP-BAND System and may not be appropriate candidates (see Contraindications).

Your tone is quite negative, but I will answer honestly. Believe me I was not given any information before banding, and afterbanding, just 30 minutes general check-up, and one page dieting information . The rest of information I got from the internet. The doctor only asked me if I was volume eater, or not, I was, and told me about other surgery possibilities, I said this was the less invasive, we should go ahead with banding, even he told me I had the option of a by-pass, to a person of BMI 38 like me???. I researched 3 days , read other peoples experiences quite extensively and made up my mind in three days, then I never thought aftercare was that important till I knew I had a VG band..

Thanks Drewslou, I wish i have seen these pictures before. One picture is worth sometimes a thousand words. I always thought they used stainless tubing in port connector. I was misled by the following pictures on Inamed site. They pretend it is made of hard material, the possibility of pucturing the connector, ot the port is higher than I thought in this case. I think some patients are allergic to metals, they only use titanium these days. I heard about stainless steel port connector though, maybe it was a thing of the past. they claim in their site: A high-compression septum and a reinforced tapered tubing connector for long-term durability

Betsyjane, I had the surgery almost on the same day, Nov 11,06, with you, you already have 3rd fill, and had agressive fill each time. I still have no restriction. How good of him to fill you so much, I bet you asked him to be agressive. I am very jealous. Any restriction so far?. Dorin

My only explanation is that you lost a lot of Water during those 2 weeks, you probably lost only 1-2 pounds of fat tissue und muscle tissue, the rest 12 pounds was probably water. One can not lose that much but water in 2 weeks. In liquid phase, people usually lose more weight, because they are not in solid diet, and have less in their intestines, and body holds less water. I had a severe cold last month. I had no appetite for 3-4 days, I could not eat any solid food, it looked like I had lost 8 pounds, but I gained those the next week once I start taking solid food. Solid food holds extra water in the body. If you take alcohol, and eat some food, the body holds more water and 6-8 pounds of fluctuations may be normal in one day, but 13lbs is too much.