Adjustments and Fills after gastric banding

Adjustments and Fills

Band adjustments are done in the clinic in the doctor’s office. The skin over the port site is sterilized. To adjust the band your doctor will inject or remove a small amount of saline from the port located under the skin of your abdomen. This procedure is generally very well tolerated and local anesthetic is not needed. Most patients say it is nearly painless.

Only a trained clinician can adjust your band. Never let an untrained clinician do it.A special needle provided by the makers of the Band MUST be used otherwise the port may be damaged and leak saline.

Generally it can take 3-5 fills before reaching your Green zone. You must wait at least a month betweenfills to allow your stomach to adjust to the tighter band and to allow you to continue to adjust your dietary habits. Afterwards you may need 1-2 fills a year life long to maintain the band tightness. This is because the saline slowly leeches out of the band, causing it to loosen over time

 The algorithms to determine the appropriate Adjustments and Fills after gastric banding may be complex. Often, it is not clear whether failure to lose weight is due to poor lifestyle with liquid or soft calories, lack of exercise, a complication(i.e. Band slippage or erosion) or improper filling. It is important to understand that the band can only help with weight loss if the patient and the bariatric team have an honest and clear understanding of what the patient is experiencing. The patient must be able to clearly communicate what they have experienced over several weeks in order for the bariatric team to make the appropriate adjustments. Adjustments must be made in small increments, and it is only through frequent visits and adjustments that the best weight loss can be achieved. It is important to note that fills are not always covered by insurance plans .


 When the band is first placed, it is usually left empty or with minimal fluid in it.The first time the Band is adjusted is at your 6 wk appointment. To determine if a fill is appropriate, at each appointment your doctor will consider:


1. Your weight loss.

The goal is 1-2 lbs weight loss a week. Do not expect more.


2. Your total calorie intake in a day.

The ideal is approximately 1200-1500 calorie a day diet divided over 3 meals. If the Band is correctly adjusted you should not feel hungry on this diet.Initially you will need to count calories every day until you become very familiar with the calories in various foods. Long term it is advisable to do a calorie count a few times a mouth to make sure you are not inadvertently taking in extra calories.

Please review the “Mindful Eating” section earlier in the Nutrition chapter.


 3. The TYPE of food you can comfortably eat.

The Band will NEVER work if you are eating liquid or soft calories. If the Band is so tight that these are the only types of food you can tolerate, the best thing to do is remove some fluid from the band. Remember more fluid is not necessarily a good thing and may actually slow your weight loss if added inappropriately.


4. Your exercise routine.

For ANY type of weight loss surgery to be successful you MUST exercise (do something you enjoy!) at least 5 days a wk for 45mins each time.


5. How much fluid is already in your band.

After the first few fills the maximum amount added at each fill is reduced. As you get closer to the ideal amount of fluid in the band (the GREEN ZONE) it may only take tiny amounts of saline to adjust the band to the correct size. Too much fluid at this stage may over tighten the band requiring fluid to be removed There will be times when you make an appointment for a fill, but your doctor decides it is not appropriate based on the above assessments. Don’t be in a hurry to have a fill before you are ready. The Band is designed to offer steady, gradual weight loss. There is no race to any finish line! Too much can very easily get you into trouble and you end up further behind than if you had gone slower with the fills.


6. After every fill you will be on a liquid diet for the first 24 hours.

You can then quickly advance to a regular Band diet.

Adjustments and Fills after gastric banding

Adjustments and Fills after gastric banding