This may help you in understanding the restrictive mechanism of a Lap-Band.

The ALLERGAN protocol for Lap-Band fills calls for a six-week delay after surgery, prior to any fills. The purpose for the six-week delay is for the patient’s stomach to heal from the surgery, as well as allowing time for the Lap-Band to “Seat” or “Nestle” into the fat pad between the stomach wall and the interior wall of the Lap-Band.

Prior to receiving an EFFECTIVE fill, it is VERY uncommon to have any restriction from a Lap-Band. Some patients will NOT lose weight, or may even GAIN weight until they have received an effective fill in their Lap-Band.

Normal weight loss with a properly restricted Lap-Band is between 1 and 2 pounds per week.

The normal cycle of fills, restriction and weight loss is as follows:

1. The patient's Lap-Band constricts when the patient receives a fill. Swelling for a few days after receiving a fill is very common. Many doctors require a patient to go on a liquid diet for a day or two after receiving a fill. A fill may have a “Delayed Action” of up to 4 weeks. A “Delayed-Action” means that the fill may not become effective for up to 4 weeks after the fill. That is why the ALLERGAN protocol states that fills should not be performed on patients who will not have access to medical care for at least two weeks after a fill.

2. The patient's stomach capacity is lessened as a result of the restriction caused by the Lap-Band.

3. The patient loses weight because they cannot eat as much food.

4. The residual fat-pad between the inside of the Lap-Band and the outside of the patient's stomach reduces in size because of the overall weight loss in the patient.

5. The reduction of the residual fat-pad causes the Lap-Band to become loose again.

6. At that point, the patient needs another fill, because the Lap-Band is loose, and the patient has a loss of restriction, which allows the patient to eat larger amounts of food.

7. The patient receives another fill and the process starts all over again.

Most Lap-Band patients receive several fills to adjust the Lap-Band as their weight loss progresses, and there is less and less residual fat-pad between the inside of the Lap-Band and the exterior of the stomach wall. Once a patient has lost all of their residual fat-pad, fills become less common. As the Lap-Band patient progresses in their weight loss, the effect of very tiny fills (Less than .2ccs) becomes greater and greater.

It is not uncommon for a late-stage Lap-Band patient to experience a significant difference in restriction with as little as .05cc of fill.

Can someone tell me why there are different size bands? I am guessing different size people?

Can someone tell me why there are different size bands? I am guessing different size people?

Different size people is correct . . . some of us have big noses, some have small, etc.

I had a small band but it slipped and then I needed a new large band because of scar tissue. That is another reason you might need a different size band.

After your first fill when should you have the next fill? After one month or two weeks? Most of what I have read have said after your first fill every 2 weeks or so until u hit that right fill. Is it common for a doctor to wait for two months between fills instead of 2 weeks? I'm so confused

After your first fill when should you have the next fill? After one month or two weeks? Most of what I have read have said after your first fill every 2 weeks or so until u hit that right fill. Is it common for a doctor to wait for two months between fills instead of 2 weeks? I'm so confused

My doc recommeds 6-8 weeks. He says it takes that long for your body to adjust to the tightness...

Does anyone else have a problem with controling their eating 3 weeks out from a fill? I don't think it should be this hard - anyone else struggling with will power? I have a 4cc maximum band; had 1 cc fill on 1/13/10. This worked for about 2 weeks and then it's been downhill ever since. I think I may need more already but can't tell if it's a psycholgical battle or physical battle I'm fighting. The fill was terribly painful (I question if this is normal) and the doc said I'd never need more than 2 cc maximum. I can't believe there are those out there having 4-5 fills. The expense! the pain! I need some reassuring advice. Anyone out there with a small (4cc) lapband?

Hi Lynn,

Its pretty normal to need another fill a couple weeks later. It feels tight at first then settles in and gets looser and/or more fat shrinks and it gets looser. Either way, what you are experiencing sounds simply as-if you need another fill.

If the band is tight enough, you will not be able to overeat (unless you eat around the band with milkshakes or whatever).

I felt the same way at 2 weeks..MULTIPLE times. 2cd guessing if the band even really does anything. Yes readers, i know it is a tool and requires work...BUT the restriction is black and white. It either IS restricting or is NOT restricting. You need a fill.

It took 8 fills and mine has been perfect now for months. One time they extracted all the fluid then refilled it. That made a huge difference. I had a 10cc band (or maybe 12 I forget now). Your is much smaller but its only 25% full!

As far as pain..where is the pain? In the port hole? Around the port? Constant in your stomach? Only when you swallow? You need to provide more info on that one.

My insurance covered the fills..or its included in the overall. Sound like you are paying al-la-carte. Sounds like you still need another regardless.

good luck.

Does anyone else have a problem with controling their eating 3 weeks out from a fill? I don't think it should be this hard - anyone else struggling with will power? I have a 4cc maximum band; had 1 cc fill on 1/13/10. This worked for about 2 weeks and then it's been downhill ever since. I think I may need more already but can't tell if it's a psycholgical battle or physical battle I'm fighting. The fill was terribly painful (I question if this is normal) and the doc said I'd never need more than 2 cc maximum. I can't believe there are those out there having 4-5 fills. The expense! the pain! I need some reassuring advice. Anyone out there with a small (4cc) LAP-BAND®?

Hi had my 3rd fill on Thursday - Total 5.5 CC.

Had a tough 4 days - including not being able to drink more than a sip of water :-(.

But my perseverance paid off - Have lost 7 pounds since my fill, and have move to thicker liquids!!! (I guess I have lost some fat around the band and swallowing has become much easier).

Really excited as I had not lost weight for more than 2.5 months!!!!

wow nice work! keep in mind you might need to do it again..or even again. Right now it probably seems perfect.

Hey, besides losing fat around the band..the fill can cause light swelling making the feel tighter than it really is. After a week or so you get used to it and the swelling goes down and it gets loser.

Why would a fill cause swelling? Beats me..BUT..this is the reason my Doctor recommends Clear to Thick to Solid for a couple days after a fill. Some Docs dont. Point is, more fills might be in your future but for today..enjoy the restriction.

Hi had my 3rd fill on Thursday - Total 5.5 CC.

Had a tough 4 days - including not being able to drink more than a sip of water :-(.

But my perseverance paid off - Have lost 7 pounds since my fill, and have move to thicker liquids!!! (I guess I have lost some fat around the band and swallowing has become much easier).

Really excited as I had not lost weight for more than 2.5 months!!!!

This post was also helpful to me. I kept thinking that my I had stopped loosing (40 lbs) because I just needed to do more, be more perfect ect. I think I am a person that wasn't getting fills like I should because I could find fault with myself; so I will call today and get one since I understand the process better.

Heya, Dr. Brad! Just a quick question out of curiosity...

You mention that your theory involves stretching of the stomach wall to shut down hunger hormones. A lot of people on here talk about "stretching the pouch," in terms of overeating to the point that the pouch is permanently (or temporarily, depending on who you talk to) dilated.

If stretching the stomach is the key to making the hungry feeling go away, how does one avoid dilating the pouch?

There seems to also be two camps on pouch dilation: the one is that it can happen without you knowing it (you can be overeating without any adverse symptoms except for feeling "full") and then there are those that say that if you're overeating to the point that you're stretching the pouch you're going to have vomiting or extreme discomfort at the time. Is either camp right? Or does the truth lie somewhere in between?

About me, I'm about 2 years post-op, doing well. Plateaued a bit the past couple months, but I still have satisfactory restriction and am increasing my exercise to bridge the gap.

Thanks for your time!

Thanks for the insight Wendell . I appreciate it, I had my 2nd fill yesterday. After the first fill no restriction, I became so discouraged. I am hoping the fill yesterday will help, now I just need to be patient with myself. When you see others losing extraordinary amounts quickly I'm happy for them, but start to think something is wrong with what I am doing. I thought maybe a cruel joke at my expense as well.

Thanks for the information on how the band works.

:thumbup:

Heya, Dr. Brad! Just a quick question out of curiosity...

You mention that your theory involves stretching of the stomach wall to shut down hunger hormones. A lot of people on here talk about "stretching the pouch," in terms of overeating to the point that the pouch is permanently (or temporarily, depending on who you talk to) dilated.

If stretching the stomach is the key to making the hungry feeling go away, how does one avoid dilating the pouch?

There seems to also be two camps on pouch dilation: the one is that it can happen without you knowing it (you can be overeating without any adverse symptoms except for feeling "full") and then there are those that say that if you're overeating to the point that you're stretching the pouch you're going to have vomiting or extreme discomfort at the time. Is either camp right? Or does the truth lie somewhere in between?

About me, I'm about 2 years post-op, doing well. Plateaued a bit the past couple months, but I still have satisfactory restriction and am increasing my exercise to bridge the gap.

Thanks for your time!

Excellent question.

There is stomach wall stretching that normally happens when food stretches the wall and activates pressure receptors which turn down appetite hormones. This is a normal process and the stomach wall remains normal.

The other type of stretching, pouch dilation, is abnormal. This is when the stomach tissue gets so stretched that it doesn't want to go back to the normal resting state. This is like a balloon that has been blown up with air way beyond its capacity and then when you let the air out it stays stretched instead of returning to its normal configuration.

To the best of our knowledge, pouch dilation, comes from pressure. The common culprits are carbonated drinks and keeping the band too tight which causes excessive regurgitation (PB-ing). I have had patients with a dilated pouch that swore that they never drank carbonated beverages and that they never PB so I think there might be a part of this that we don't completely understand.

The good news is that it is fixable. Many times deflating the band for three weeks will resolve the dilation or if severe, we can reposition the band surgically though some patients describe that the band acts different after a revisional surgery like this.

Increasing your calorie burning is absolutely the right approach to getting out of a plateau.

Hope that helps

brad

Thank you for some useful information! This was very helpful in understanding my progression.

My surgery was December 10th and my total weight lost of 24 lbs. I've had two fills...but after the second fill I had to have a slight unfill. So I'm not at my "sweet spot" yet, andv not losing near as fast as I had hoped!

Interesting good info./opinions here. I'll add some of my experience in case it helps someone else. Let me start by saying I respect that everyone needs to do what works for them.

I'm allowed up to 1.5C at meals. I usually eat 1C; NO way could I get in all my nutritional requirements on 1/2C at meals and I've NEVER found a bander who could show me they're meeting nut requirements on 1/2C per 3 meals of solids yet. The band works with eating solids, not liquids (If you want to go on a liquid protein diet you can do so without the band).

I'm allowed carbonation. I have carbonation several times a week since healing...my doc says the carbonation stretching is a LB rumor (some docs started to get patients to stop drinking high cal beverages/yes, there's a huge correlation between soda and obesity), no scientific truth to it- your pouch has not one but TWO air exits and gas will exit easily before it stays and stretches anything; think balloon with 2 straws sticking out of it).

I'm at my sweet spot and I can still eat anything (and do, in moderation). You do NOT have to have your band so tight that it restricts your eating or you develop a long list of things you can't eat. The trick after each fill is NOT to see how much you CAN still eat...it is to see how little you can eat and still meet your Nut requirements and still be satisfied between meals.

I just had my yearly upper GI and everything is the right size, in place, etc. I reached goal at 10 months (90 lbs.) with about 1200 cals a day (and not a ton of exercise). I'm not saying it hasn't been hard work, but the band doesn't have to create yet another 'diet' mentality and limit things you can't eat. Yes, it's been slower and harder to learn to eat right for a lifetime where I'm not restricting anything (I was a GREAT yo-yo dieter), but I'm not doing anything differently now that I didn't do my first day back on solids.

Good luck on your WL journey!!

I've been blogging everything since I first got started, come join me, link below.

Edited April 3, 201016 yr by Band_Groupie

hi wendall great stuff you have said i was banded june 2009 but have not lost very much from like 311 to like 284 i am frustrate i have hd 3 fills in an allergan lap band