Band Adjustments, who/what/where/when/how/why

[VegasGrace 1]

So many search the forum for this information. This isn't a secret...and it's straight from Inamed.

This describes exactly how much fills should be. When fills should be given, when they shouldn't be.

Make this a sticky so everyone will have this info.

Straight from the manual:

INSTRUCTIONS FOR USE: BAND ADJUSTMENT

Postoperatively, the surgeon may adjust the stoma size percutaneously by injecting or aspirating saline with the access port needle via the self-sealing access port.

The following are general guidelines for LAP-BAND System adjustments:

1. The initial postoperative adjustment should occur 4-6 weeks after the operation. In most cases, you will add 1-2 cc of saline to the 9.75 and 10 cm LAP-BAND, 2-3 cc to the VG LAP-BAND, and 4 cc to the 11 cm LAP-BAND.

2. The patient should be reviewed regularly (every 4-6 weeks) and weight and clinical status measured. If the weight loss has averaged less than 1 lb per week over the period and the patient indicates there is not excessive restriction to eating, a further increment of Fluid should be added (usually 0.3 - 0.5 ml)

3. Where the average weight loss between visits has been greater than 2 lbs per week, normally no additional Fluid would be added.

4. If the weight loss has averaged between 1 and 2 lbs per week, additional fluid would be indicated if the patient feels he/she can eat too freely or finds difficulty in complying with the dietary rules.

5. Fluid would be removed from the system if there were symptoms of excessive restriction or obstruction, including excessive sense of fullness, heartburn, regurgitation and vomiting. If symptoms are not relieved by removal of the fluid, barium meal should be used to evaluate the anatomy.

Prior to doing an adjustment to decrease the stoma, review the patient's chart for total band volume and recent adjustments. If recent adjustments have not been compliant with nutritional guidelines, the patient my have a leaking band system, or may have a pouch enlargement or esophageal dilation due to stomal obstruction, band slippage or over-restriction.

Band system patency can be conformed by injecting saline into the band system, then immediately withdrawing it. An absence or decrease in fluid volume indicates a leak in the system may exist. The band may be evaluated for a leak using a radiopaque solution, such as Hypaque or Conray-43, flushing it from the band system after the evaluation. If pouch enlargement or band/stomach slippage is suspected, a limited upper GI with a samll amount of barium or gastrograffin can be used to evaluate the size of the pouch, the gastric stoma and the position of the band.

CAUTION: Insufficient weight loss may be a symptom of inadequate restriction (band too loose). Or, it may be a symptom of pouch or esohpageal enlargement, and may be accompanied by other symptoms, such as heartburn, regurgitation or vomiting. If this is the case, inflation of the band would not be appropriate.

The band internal diameter may be decreased approximately 0.5mm by adding an additional 0.4 cc of sterile saline. Excessive restriction may result in a closed stoma. Because of the possible complications that can occur with excessive restriction, a doctor familiar with the adjustment procedure must be available for several days post-adjustment to adjust the stoma in case of emergency.

Deflation (an increase in stoma size) is considered if the patient experiences frequent episodes of vomiting, is unable to swallow liquids or appropriate foods, or if there are medical indications for increasing nutrient intake. the internal diameter of the band can be increased approximatley 0.5mm by withdrawing 0.4 cc of the fluid. Elective deflation of the band is advisable in the following situations:

Pregnancy

Significant concurrent illness

General anesthesia

Remote Travel

Travel to areas where food or Water contamination is endemic.

[Boo Boo Kitty 3]

I agree that this is from Inamed, however this is JUST a guide. I can tell you that I could never tolerate their suggestions and therefor, had to work with my Dr on adjustments.

This is a guide, not an absolute because every band is different and every body is different. I do think it is a good guide. How much, when and why you get a fill is ALWAYS up to the Dr and the patient.

[*susan* 1,709]

There is already quite a bit of information in the two stickies at the top of this forum. Other questions regarding the band and fills can be found in the FAQ (frequently asked questions) forum here:

Lap-Band Surgery FAQs and References - Lap Band Talk Forum - The largest forum for Lap Band Surgery Discussion and Lap Band Surgery Support