The adjustable laparoscopic band (ALB) is usually placed in the abdomen with very little or no fluid it. Your weight loss surgeon wants the Lap-band to heal in place, allowing your body to get used to this new foreign object before you begin putting food into your stomach. Typically, this means the diet progression in the ALB is different from and much slower than diets of other weight loss surgery patients.

Vomiting is the enemy here, as early repeated vomiting can cause displacement of the Lap-band. If your Lap-band becomes displaced, you will need to go back to the operating room to have it adjusted. So, follow your weight loss doctor’s instructions closely about diet progression.

The day after Lap-band surgery, or later in the afternoon on the day of your operation, you will get a barium swallow (this is where you go to the x-ray room and drink some chalk-tasting fluid). This swallow will show the them that fluid is going through the Lap-band area, and that the it is in its proper position.

Some patients will feel as if they cannot even swallow their saliva. They will stay in the hospital a few days for IV fluids while the swelling goes down. This can occur even though barium goes through the lap-band area into the lower stomach. Medications can be given to dry out the secretions and to make the stomach work a little better, but this is a temporary condition that will clear up on its own if given a little time.

Week 1-2Week 2-3Lap-band fillWeek 3 and on
See the clear liquid diet recommendations. Sip from one-ounce cups, and sip no more than 1/3 of that cup at a time.Full liquid diet. Avoid swelling foods: no bread, no rice, and no pasta. Avoid fiber.Go back to clears for 2 days—sip, sip, and sip. Do not tempt your Lap-band at this time.Go to a puree diet, and advance to soft then to solid foods. BUT the foods must be small bites.

Progression of the diet for patients who have the lap-band surgery varies greatly. Some weight loss doctors allow you to have a full liquid diet by the second week and to slowly increase your intake from that point. Again, the enemy here is vomiting, and early introduction of too much food can cause severe vomiting.

The first few weeks after Lap-band surgery, unlike other weight loss surgeries, are not meant for weight loss. This is an adjustment period for you to learn to use your tool. Learn to take small sips of clear liquids. Give your stomach a chance to get used to Lap-band surgery. This is not the time to experiment with food or to try something new. This is the time to sit back and enjoy a liquid diet while allowing the Lap-band to scar into its new home. After the second week, you can begin the full liquids—things like yogurt go down quite well. Some weight loss surgeons consider yogurt a “clear liquid” and will allow that the first week.

Filling the Lap-band

−the stoma is closing, all aboard…

Most weight loss surgeons place the lap-band into the abdomen without fluid in the balloon (a fill) and wait several weeks (sometimes six to eight) before the first fill. More often than not, you will feel a restriction even though no fluid has been placed in the device. It is also normal not to feel a restriction of the stomach at first. By restricted, we mean that you will feel full with less, usually less than a cup of food will fill you. Without the restriction, your stomach can accommodate a small water buffalo. The initial restriction you feel is just swelling from the operation. This swelling reaches its maximum at about one week after the procedure and can last for up to six or seven weeks. As the swelling begins to decrease and the Lap-band has healed into place, your weight loss surgeon may put some saline into the port, causing the balloon to fill, which will restrict your outflow stoma.

 

The lap-band fits around the top part of the stomach and is adjustable. If we tighten it too much no food will get through. If we do not “fill” it then there will be no restriction, and you will not feel full with less. The trick is to have a “fill” that tightens it “just right.” That way, you feel a restriction with a bit of food, and the food is allowed to slowly go to the lower stomach, keeping you full longer.

The first fill may not be very much (just a few cc’s of saline),but it may have a profound effect on how you feel. Filling the balloon will tighten the stoma, so you will feel quite restricted where you didn’t before. You will feel that a bite or two will fill you up, and you will have no appetite for more. Some weight loss surgeons do the first fill in x-ray while you drink some dye (barium). This way they can close the Lap-band, watch the barium sit in your esophagus, and then gently open it so there is a restriction. Other weight loss surgeons will do the fill in their office and judge their fill according to the patient’s response.

Before the fill, it is best not to have anything but water on your stomach. Every weight loss surgeon has a different protocol for this. Most will ask that you have nothing to eat after midnight and will allow you to drink water up to two hours before your fill.

The goal is to design your pouch and stoma so that you are satisfied with a small amount of food.There is an art to filling the Lap-band. The first time it is filled, you will feel a restriction to the intake, then as time goes on it goes away. That is the time for another fill. A lot of this will depend on the protocol that your weight loss surgeon uses. If he does the first fill in x-ray, you will feel a restriction. If he “fills” in the office, he may want to creep up on the restriction.

Every weight loss surgeon has a different protocol for filling the Lap-band. In Tijuana, my friends like to do their fill in x-ray, but the cost of the X-ray and the fill is only $150. Again, the cost savings of medical care in Mexico is passed on to the patient. In the United States, X-ray can be an expensive option, so many weight loss surgeons will do adjustments in their office.

Remember—after your adjustment, the rule is “clear liquid diet” for two days. There will be some swelling and your body needs to get use to your new anatomy. Vomiting can still displace the Lap-band. If that happens, it means you will have to go back to the operating room to have the device put back in place.