FILL FACTORS are things that make your fill work better for you. They will help make certain your fill is accurate the first time and limit the possibility of you having to have an immediate readjustment. You may need to have a few extra adjustments when you first receive the lap-band. This will subside and it all will be second nature to you once you get the hang of it.
Lap-band fill factors
Laparoscopic band (Lap-band) fill guidelines
Adjustments are made to allow the Lap-band to suppress appetite for a prolonged period of time. Adjustments are not meant to make you stop eating. The Lap-band is a guide, it is not a collar.
We do not like “hard stops,” that is, where you eat until you “feel full.” We do not use the word “restriction,” except when we illustrate a diagram, such as above. Otherwise, restriction would be a “feeling,” and we do not subscribe to that. The Lap-band does not work by “feeling restricted,” and those who seek that term do not lose the weight they should.
You know you need a fill when a small amount of food is not lasting you an appropriate period of time. When you find yourself looking for food — and feel as if you are dieting.
Before your Lap-band Adjustment
We would prefer you not eat for two hours before the fill to allow the pouch to empty. While some would say longer, we find no evidence that this is helpful.
Lap-bands are tighter anytime you have swelling — when you are ill, if you have a menstrual period, or if you have allergies. It is unwise to fill a person during these times — although we can.
After your Adjustment– too tight
If you are having difficulty drinking water after a fill, or vomit up the water you had– email us immediately and come in for an un-fill. Water should go down easily.
During the fill, if water is pooling in the upper pouch — let us know– you are too tight.
Too tight a Lap-band can lead to a slip — water should go through easily.
Post Lap-Band Adjustment — diet
We want you to drink liquids for about a day — to make certain they go down. Then progress to regular food.
Foods to avoid post fill:
No rice, bread, pasta. Those things cause stoma occlusion (blockage). One very nice patient ate a pastry – -it became stuck, and ultimately she had a slip.
No chicken — and certainly don’t combine chicken with rice, breads, tortilla, or pasta. Introduce chicken slowly. We have some excellent chicken recipes — but chicken has fiber content that becomes lodged very tightly in the Lap-band and takes time to get it out.
First Lap-band fill
The first fill is done by Dr. Simpson. He will aspirate the fluid in your Lap-band so he knows how much is there. The various Lap-bands hold different amounts. He will then fill you to a level where he feels some back pressure, and stop.
Most patients get their first fill two weeks after they are stable with eating solid food. After the first fill patients typically get two additional fills at monthly intervals. The reason for the additional fills is that the Lap-band is placed over soft fat around the stomach which must be displaced. Sometimes there may be a few mechanical things we must work out with fills at the outset. While everyone is different – on average people need four to six fills in the first year and two to three in the second. Our goal is to get you to the “sweet spot” where a small amount of food keeps you until the next meal.
Typically, you will notice appetite suppression after the first fill. We do not want you to feel “restriction.” We want you to be able to eat a small amount. After the first fill this lasts about one to two months — then most are ready for another fill.
It typically takes 3-6 fills to reach the “sweet spot” where a small amount of food keeps you satisfied for a long period of time — and where you don’t need to come in monthly for an adjustment. But you will have this sweet spot along the journey. Use this time to reinforce measuring your portions, eating slowly, and small bites. You can drink small swallows of non carbonated fluids while eating. Drinking this way will moisten food and may help to avoid food sticking in your Lap-band.
The Lap-band is tighter in the morning for some people, so they cannot eat breakfast. That is ok. We want you to eat a lunch and a dinner. We want you to eat slowly — over 15 to 20 minutes, but stop at 30 minutes. We want you to eat nothing larger than the fingernail on your little finger. Eating fast, eating too much, and eating too large a bite can lead to a Lap-band slip– which can lead to another surgery — which is not what you want.
Port flips and leaks
Ports can flip or they can be defective, or they can leak. National studies show these events happening in 1.8% of all surgeries — our results are better than that. If we cannot easily access a port, we will ask you to come back again. We may feel that we need to revise it surgically, attempt to fill under x-ray or with ultrasound guidance.
Port Flips may occur because of the way your body heals — and while our method of securing the port works well, and is considered a national standard — the body can scar in such a way that the scar tissue can pull a port. More often someone does something to dislodge a port — abdominal crunches, exercise, stretching. We want you to be active — but if your port hurts, stop.
Tubing can leak or become disconnected. These events are extremely rare. But, this is a mechanical device. Things happen. We can fix them.