I've been meaning to ask my doctor why we need fills? We get a fill and then feel restriction, then by the time it is time for another fill, we begin feeling hungry sooner? Which implies that the passage way between the stoma and stomach gets increases in size? I don't get it yet.

I'm no expert but this is what I understand.

Right after surgery the stomach is swollen so no additional restriction is necessary. As the stomach heals and the swelling goes down the restriction related to the surgery disappears. That is the time when people start to get fills. The band is sort of like an inner tube that goes around the stomach. As you fill the inside of the inner tube it gets tighter and tighter around the stomach. The saline stays on the inside of the band. Whatever type of band you have the first fill is usually a small percentage of the available space inside the "inner tube." That is sometimes enough for the person to feel adequate restriction. If that is not enough, you get another fill. Sometimes people need 6 or 8 fills to get where they want. Sometimes a person has adequate restriction with no fills, or one fill. You keep getting fills until you feel the restriction you need.

Another issue is that sometimes the restriction from the fill does not show up right away, and a person can then sometimes find that they have too much restriction a week later, when they did not feel that amount of restriction right after the fill. Then the person may even need to get partially unfilled. So it is a process of adjustment until you find the "sweet spot," where you have good restriction, but not too much restriction. The process is different for each person.

Also, fills are done in different ways. Sometimes it's just a matter of adding a little at a time until you get the restriction you want. Other doctors do fills under a flouroscope which lets them see inside and attempt to get close to the exactly the right amount of fill the first time.

That may not be exactly right, but from reading this forum for a while I think that's close.

The way it was explained to me is this:

Think of the band like a belt. As you lose weight you must tighten a belt as your waist is getting smaller. The stomach is the same, it gets smaller as you lose weight and the band must be made tighter to remain effective. So as you lose weight the stomach also gets smaller making the band less restrictive. Get it? I think I explained that right. ~Mandy

Also, my doc said that there is a lot of fat around the stomach, and when you lose it, the need for a fill arises