Why do you have to continune to get fills?

Nancy · April 3, 2007

Does the band leak, or evaporate? I don't have the band yet, but I just found out today that my insurance approved me!! IM excited and scared.

Nan

juliegeraci · April 3, 2007

Hi Nan, welcome to lapband talk forum. You need to get fills to have restriction. Typically the band loosens when you start losing weight. I need a fill every 10 lbs or so. I have had 5 fills in 10 months. Yes, my Fluid did evaporate. The surgeon told me I had a small weepy tube. No big deal. It was fixed with a solution they can put in for that. Kind of like fixing a flat tire. Good luck on your journey. Julie

Nancy · April 3, 2007

Thanks Julie...Do the fills hurt? How long do they usully take?

nan

juliegeraci · April 3, 2007

Hi Nan, the fills don't hurt themselves. The needle the surgeon uses to numb the port are stings a little bit. I don't know if your doctor uses a numbing agent or not. Some to not. A fill literally takes 5 minutes. They take out the old saline to see how much is there and then they fill and sit you up to drink Water to see how tight you are. Its really easy. Good luck to you. Julie

Nancy · April 3, 2007

Does the band really FORCE you to not over eat? This is one of my major problems...I have a sweet tooth and I also over eat the right kind of food. I have a very healthy appitite and I need something that is physically going to restrict me.

Nan

juliegeraci · April 4, 2007

Hi Nan, yes! The band is designed to give you restriction. With restriction you still have to make wise food choices but if you follow the bandsters rules you will not overeat. I can only eat 1/2 cup of food at a time and I'm at 3ccs in a 10ccs band (which holds 4.2). You can PM me if you want more info. I don't mind. Julie

Nancy · April 4, 2007

Nan...
The band is an enclosed system so it does not leak unless it is faulty or surgeon error.

The reason for fills is because during surgery the surgeon will remove a bit of perigastric fat. This is one of the many reasons you need a very experienced surgeon. He has to remove just enough so that you have some restriction but not too much. The fat pad above the band provides some natural restriction from the weight alone. As you lose weight you lose some of that fat pad and lose some restriction, thus... a fill.

Also, sometimes you might want more restriction, sometimes you might want less. Per Dr. Ortiz 70% of patients don't need a fill for six months. Some never need a fill.

The band doesn't force anything, if you are full and you continue to eat there really isn't anything that can work at that point. But typically if people are satisfied vs. hungry, they have much better control over their eating habits. When we diet we are depriving ourselves, we are hungry all the time and it is soooooo easy to cave and eat the wrong foods.

If you do over eat with good restriction it is called pouch packing. I just saw an xray of someone last week that has been pouch packing. His esophagus is stretched out and kinda gross looking. He has not just stretched out his pouch, he stretched out his esophagus. Now he's on liquids for a month.

Fills don't hurt a great deal because unlike your fingertip, there are few nerves in the area of your stomach that they access your port. It's a piece of cake.

Thank you for your feedback...This is exactly what I am afraid of. I just hope that this is the tool that will stop me, or at least teach me to stop.

nan

fabfatgrl · April 4, 2007

Fills don't hurt at all. Actually, IMHO, it's much easier to have a fill w/o anesthesia (usually they'll offer to numb you with a topical)... rather than with. Hurts a lot more to get the topical, than the fill

As for needing fills forever... more recent studies have shown that the Band's membrane is semipermeable. So, you may need to get things checked every 6 months or so once you're on maintenance... especially if you feel like you're losing restriction (and don't want that).

From the May 2005 issue of Obesity Surgery

Permeability of the silicone membrane in laparoscopic adjustable gastric bands has important clinical implications.

* Dixon JB,

* O'Brien PE.

Australian Centre for Obesity Research and Education, Monash Medical School, The Alfred Hospital, Melbourne, Australia. john.dixon@med.monash.edu.au

BACKGROUND: The single most important attribute of the laparoscopic adjustable gastric band (LAGB) is its adjustability. Having the correct volume of Fluid within the band is crucial for optimal performance. We observe a small reduction of the satiety-promoting effect with time. The characteristics and clinical relevance of volume change have not been adequately investigated. METHOD: One observer measured the saline volume within the 10-cm Lap-Band in 118 consecutive patients who fulfilled the entry criteria. The same observer had performed and recorded the previous adjustment. Initial volume, final volume and time between observations provide the data for analysis. In addition, a range of adjustable gastric bands currently available were bench-tested to assess broad applicability of findings. RESULTS: The difference between observations varied from 0.0 ml to -1.0 ml, median of -0.1 interquartile range (IQR) 0.0-0.2 ml. Two factors were associated with volume change: time in days between the observations (r = -0.55, P<0.001) and the initial volume within the band system (r = -0.50, P<0.001). These two independent factors accounted for a significant proportion of the variance observed (Cox and Snell R2 = 0.45, P<0.001). Replacement of any discrepancy appears to maintain effectiveness. All six bands showed similar saline loss when bench-tested. CONCLUSION: Adjustable gastric bands are semipermeable, leading to a small reduction in saline volume with time. Patients should be informed of this effect, attend for regular follow-up visits and seek help if the band's effectiveness appears reduced. We recommend that the volume present should be checked and readjusted at least every 6 months.

PMID: 15946451 [PubMed - indexed for MEDLINE]

And from an earlier study in European Radiology from 2001

pontaneous volume changes in gastric banding devices: complications of a semipermeable membrane.

* Wiesner W,

* Hauser M,

* Schob O,

* Weber M,

* Hauser R.

Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland.

The goal of this study was to prove that adjustable laparoscopic gastric banding (LAP-BAND) is semipermeable and that luminal adjustment with saline leads to spontaneous Fluid loss, luminal widening, and effect loss which makes repeated readjustments necessary. In 64 patients stoma adjustment was performed with saline according to the guidelines of the manufacturer (group 1). In 32 patients hyperosmolar contrast material was used for stoma readjustments with the intention to detect a system leakage after spontaneous fluid loss and spontaneous luminal widening was observed (group 2). After spontaneous luminal narrowing had occurred in group 2, all patients from group 2 and all additional patients (n = 148) underwent stoma (re-) adjustment with iso-osmolar contrast material (group 3). Spontaneous fluid changes which led to spontaneous changes of the luminal width were then analyzed for the different filling substances in each group. Fifty-two patients from group 1 presented with effect loss because a spontaneous luminal widening had occurred secondary to a fluid loss of 0.1-0.2 ml/month. All 32 patients from group 2 presented with increasing obstruction and food intolerance because a spontaneous luminal narrowing had occurred secondary to a spontaneous fluid gain of 0.1-0.3 ml/month. In our patients from group 3, where stoma adjustment was performed with iso-osmolar contrast material, no spontaneous fluid changes were observed and luminal width/degree of obstruction did not change. The LAP-BAND is semipermeable. Stoma adjustment should not be performed with saline in order to avoid spontaneous luminal widening and the need for repeated readjustments. Stoma adjustments with hyperosmolar contrast material are clearly contraindicated since osmotic fluid gain leads to increasing obstruction. Stoma adjustments should be performed using iso-osmolar filling media which provide a stable luminal obstruction.

PMID: 11288845 [PubMed - indexed for MEDLINE]

As for overeating, if you eat too much, you will PB (productive burp... like regurgitating more than vomiting.) HOwever, some foods seem to slide right through... ice cream, candy, Cookies, etc. Sadly. There are tricks, though.... like adding fruit to your ice cream, etc.

spencd1 · April 5, 2007

Fills don't hurt at all. Actually, IMHO, it's much easier to have a fill w/o anesthesia (usually they'll offer to numb you with a topical)... rather than with. Hurts a lot more to get the topical, than the fill
As for needing fills forever... more recent studies have shown that the Band's membrane is semipermeable. So, you may need to get things checked every 6 months or so once you're on maintenance... especially if you feel like you're losing restriction (and don't want that).

From the May 2005 issue of Obesity Surgery

Permeability of the silicone membrane in laparoscopic adjustable gastric bands has important clinical implications.

* Dixon JB,

* O'Brien PE.

Australian Centre for Obesity Research and Education, Monash Medical School, The Alfred Hospital, Melbourne, Australia. john.dixon@med.monash.edu.au

BACKGROUND: The single most important attribute of the laparoscopic adjustable gastric band (LAGB) is its adjustability. Having the correct volume of Fluid within the band is crucial for optimal performance. We observe a small reduction of the satiety-promoting effect with time. The characteristics and clinical relevance of volume change have not been adequately investigated. METHOD: One observer measured the saline volume within the 10-cm Lap-Band in 118 consecutive patients who fulfilled the entry criteria. The same observer had performed and recorded the previous adjustment. Initial volume, final volume and time between observations provide the data for analysis. In addition, a range of adjustable gastric bands currently available were bench-tested to assess broad applicability of findings. RESULTS: The difference between observations varied from 0.0 ml to -1.0 ml, median of -0.1 interquartile range (IQR) 0.0-0.2 ml. Two factors were associated with volume change: time in days between the observations (r = -0.55, P<0.001) and the initial volume within the band system (r = -0.50, P<0.001). These two independent factors accounted for a significant proportion of the variance observed (Cox and Snell R2 = 0.45, P<0.001). Replacement of any discrepancy appears to maintain effectiveness. All six bands showed similar saline loss when bench-tested. CONCLUSION: Adjustable gastric bands are semipermeable, leading to a small reduction in saline volume with time. Patients should be informed of this effect, attend for regular follow-up visits and seek help if the band's effectiveness appears reduced. We recommend that the volume present should be checked and readjusted at least every 6 months.

PMID: 15946451 [PubMed - indexed for MEDLINE]

And from an earlier study in European Radiology from 2001

pontaneous volume changes in gastric banding devices: complications of a semipermeable membrane.

* Wiesner W,

* Hauser M,

* Schob O,

* Weber M,

* Hauser R.

Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland.

The goal of this study was to prove that adjustable laparoscopic gastric banding (LAP-BAND) is semipermeable and that luminal adjustment with saline leads to spontaneous Fluid loss, luminal widening, and effect loss which makes repeated readjustments necessary. In 64 patients stoma adjustment was performed with saline according to the guidelines of the manufacturer (group 1). In 32 patients hyperosmolar contrast material was used for stoma readjustments with the intention to detect a system leakage after spontaneous fluid loss and spontaneous luminal widening was observed (group 2). After spontaneous luminal narrowing had occurred in group 2, all patients from group 2 and all additional patients (n = 148) underwent stoma (re-) adjustment with iso-osmolar contrast material (group 3). Spontaneous fluid changes which led to spontaneous changes of the luminal width were then analyzed for the different filling substances in each group. Fifty-two patients from group 1 presented with effect loss because a spontaneous luminal widening had occurred secondary to a fluid loss of 0.1-0.2 ml/month. All 32 patients from group 2 presented with increasing obstruction and food intolerance because a spontaneous luminal narrowing had occurred secondary to a spontaneous fluid gain of 0.1-0.3 ml/month. In our patients from group 3, where stoma adjustment was performed with iso-osmolar contrast material, no spontaneous fluid changes were observed and luminal width/degree of obstruction did not change. The LAP-BAND is semipermeable. Stoma adjustment should not be performed with saline in order to avoid spontaneous luminal widening and the need for repeated readjustments. Stoma adjustments with hyperosmolar contrast material are clearly contraindicated since osmotic fluid gain leads to increasing obstruction. Stoma adjustments should be performed using iso-osmolar filling media which provide a stable luminal obstruction.

PMID: 11288845 [PubMed - indexed for MEDLINE]

As for overeating, if you eat too much, you will PB (productive burp... like regurgitating more than vomiting.) HOwever, some foods seem to slide right through... ice cream, candy, Cookies, etc. Sadly. There are tricks, though.... like adding fruit to your ice cream, etc.

I was banded on December 9, 2006. All is going well, I'm down 50 pounds and feeling pretty good. I've been measuring my food out 3 times a day, at 1/2 cup. Trying to get in all of the protien possible and drinking, drinking, drinking. I really have no restriction at all and I find myself cheating. For some crazy reason, I am totally affraid of getting a fill. Was anyone else worried?

Please, any help or support would be very much appreciated. I don't mean to horn in here and I'm sorry for that.

ReneBean · April 5, 2007

Fear of fills - yeah. It was a while before my first fill, too. I mean, I had heard horror stories about PB's or not being able to eat certain foods... somewhere in the back of my brain, I was still resisting the band.

So, I went in and got one. I made sure not to look at the needles (cause that really would scare me) and was prepared for anything.

The end result was that the first fill gave me some restriction for about 15 minutes... then the swelling went down.

I have had a lot of fills since then... but only one PB - which was totally my fault. I wasn't paying attention, I was eating the wrong food, and I was talking to my DH at the same time... Not the plan, at all.

So, no horrible PB's. Scratch one terror. Then there was that "not being able to eat _ ever again" fear. Uh.... yeah. I can still eat any darned thing I want. It's more difficult to eat fluffy bready things... but not impossible. Scratch fear number two.

So, I would definitely get that fill right away. It will probably be the first of several before you get restriction - and it will probably NOT do any of the things you are worried about.

Good Luck!!

louise162 · April 5, 2007

There has been some research recently that the band is semi-permeable and that very small amounts of saline leak out over a period of time. This means that even after you think you've had it adjusted just right you may need an annual adjustment.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11288845&dopt=Abstract

I've had two fillls in as many weeks and they are not too traumatic. All I feel is a sharp scratch when the local anaesthetic goes in and then nothing.

Best of luck!