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.

Wendell,

Thanks for the post - good information. I am new to this site, and this is my first post. I have a question about fills. Who determines the need for a fill? Can I go in a request a fill when I feel the need, or is this dictated by the doctor? Currently, I am pre Op, but I've been approved by Insurance. 7 Jan is the day I go in to discuss a surgery date (I guess). Also, I read on another post, that there was some "sewing" done on the stomach, attaching the band to it? I didn't think there was any sewing involved? I thought they put the band on the stomach and that was it? Anyone have any clarification to this? Thanks so much!

I think usually you decide when you need a fill. It is when you stop feeling restriction and can eat a lot more than you should.

As i understand they sew either stomach or the stomach fat layer over the band. It helps a lot to prevent slippage. Also it may be that different docs do different things....

I am required to see my Dr every month for a year and we decide on fills at that time. I am only two weeks post op and luckily feel full on liquids most of the time. My Dr. Explained he sewed the stomach around the band to prevent slippage.

I had my first fill the other day the doctor put in 10cc. It has been three days and I have no restriction. Should I have another fill or am I not waiting long enough for it to work? Also when I say no restriction I can eat anything and it just goes right through, I am getting frustrated also I want to eat small but the band is not working!!!!!

100cc's ???

That seems like a lot for a 1st fill.

What size and brand is your Lapband?

I have a 10 cc band and my fills went like 5, 2.5, 1cc, 3/4 cc until I had restriction.

It usually takes 2-4 fills before you feel restriction. So it is also not uncommon for some folks to need 5 or 6 especially if its a larger band.

Good luck!

Peaches Ditto

I have a 10cc band and first fill was 6cc and the second was 2.5. I hit the 'sweet spot' on the second fill.

Perhaps there is something like a 14cc band Isavada? Do you know what your band size is?

Thanks so much for this posting. It helps me out A lot !!!

Thank you for your informative post. I was banded in February 2007. I had my first fill of 1.3 in April, lost about 20 pounds. In June I got filled to 1.8 because I had stopped losing and couldn't feel restriction as much. This fill was perfect until about 3 weeks later when I couldn't eat or drink without major pain and vomiting. I went back to 1.3 and again it felt perfect! Then, 3 weeks later same thing happened with pain and vomiting. I then had the fill completely removed for 6 weeks. Could eat just about anything. Went back on Dec. 27 for a 1.3 fill. Again felt great could eat but was restricted after small portions. No pb's or vomiting or pain. Then 1 week later and with the start of my menstrual cycle the tightness, vomiting, and pain started again. I am barely getting down broth.

Sorry for the length of this I am just worried and frustrated.

I found it interesting in your post that a fill can take 4 weeks to take effect. I'm guessing that I just need a smaller fill. I'm wondering if I should go down to .8? I really don't want to have the whole fill removed again. What is your advice? Also, does my menstrual cycle play into this? It seems I get tight at this time.

Thanks in advance for your help.

I AM JUST A NEWBIE TO THIS SITE AND THE BAND AND THIS EXPLANATION WAS A HUGE HELP I HAVE BEEN THROUGH SOME MEDICAL SCHOOLING SO I AM REALY ABLE TO UNDERSTAND WHAT YOU MEAN!

I GET MY FIRST FILL ON 2-5-08 AND CAN'T WAIT!:rofl::hungry:

Thank you for your informative post. I was banded in February 2007. I had my first fill of 1.3 in April, lost about 20 pounds. In June I got filled to 1.8 because I had stopped losing and couldn't feel restriction as much. This fill was perfect until about 3 weeks later when I couldn't eat or drink without major pain and vomiting. I went back to 1.3 and again it felt perfect! Then, 3 weeks later same thing happened with pain and vomiting. I then had the fill completely removed for 6 weeks. Could eat just about anything. Went back on Dec. 27 for a 1.3 fill. Again felt great could eat but was restricted after small portions. No pb's or vomiting or pain. Then 1 week later and with the start of my menstrual cycle the tightness, vomiting, and pain started again. I am barely getting down broth.

Sorry for the length of this I am just worried and frustrated.

I found it interesting in your post that a fill can take 4 weeks to take effect. I'm guessing that I just need a smaller fill. I'm wondering if I should go down to .8? I really don't want to have the whole fill removed again. What is your advice? Also, does my menstrual cycle play into this? It seems I get tight at this time.

Thanks in advance for your help.

V

I would change my eating pattern when the pain and vomiting begins....warm liquids for a few days. Send food through a blender and make sure you take only 1/2 a cup slowly. The pain and vomiting could be triggering your stomach to swell so you want to wait until the swelling is down before you eat regular food again........

Yes, everyone says that they are much tighter while it's that time of the month.

That is good advice. Try to stay on liquids and Soups if you're having trouble. Don't even try solids. Everything is aggravated in there and it will just compound the problem.

Some people are very sensitive to fills and can't handle much of a fill.

Thank you for your informative post. I was banded in February 2007. I had my first fill of 1.3 in April, lost about 20 pounds. In June I got filled to 1.8 because I had stopped losing and couldn't feel restriction as much. This fill was perfect until about 3 weeks later when I couldn't eat or drink without major pain and vomiting. I went back to 1.3 and again it felt perfect! Then, 3 weeks later same thing happened with pain and vomiting. I then had the fill completely removed for 6 weeks. Could eat just about anything. Went back on Dec. 27 for a 1.3 fill. Again felt great could eat but was restricted after small portions. No pb's or vomiting or pain. Then 1 week later and with the start of my menstrual cycle the tightness, vomiting, and pain started again. I am barely getting down broth.

Sorry for the length of this I am just worried and frustrated.

I found it interesting in your post that a fill can take 4 weeks to take effect. I'm guessing that I just need a smaller fill. I'm wondering if I should go down to .8? I really don't want to have the whole fill removed again. What is your advice? Also, does my menstrual cycle play into this? It seems I get tight at this time.

Thanks in advance for your help.

I've had patients that were way too tight when they were on their menstrual cycle. For that I would advise against having surgery while on your cycle.

If the band gets much tighter on your cycle it suggest that you're retaining Fluid and maybe a diuretic (pill that makes you pee) would be indicated while you are on your cycle.

Also, salt intake can affect band tightness. Some patients are really tight the next day when they have a high salt meal.

Also, if your thyroid has never been checked it may be a good idea to check it. Thyroid problems can cause fluid retention among other things.

hope that helps

Dr.Watkins,

Great to see you back on the sight again, I so enjoy all your great info. you give to us. Its so nice of you to take your time and expertise and share with us.

Colleen

I've had patients that were way too tight when they were on their menstrual cycle. For that I would advise against having surgery while on your cycle.

If the band gets much tighter on your cycle it suggest that you're retaining Fluid and maybe a diuretic (pill that makes you pee) would be indicated while you are on your cycle.

Also, salt intake can affect band tightness. Some patients are really tight the next day when they have a high salt meal.

Also, if your thyroid has never been checked it may be a good idea to check it. Thyroid problems can cause fluid retention among other things.

hope that helps

Thank you so much for your reply I will try a diuretic on my next cycle. I also had never thought of my salt intaking affecting it , but that does make sense. I did end up having .5 taken out and am feeling much better, I hope it continues.

Thanks again!

V

I would change my eating pattern when the pain and vomiting begins....warm liquids for a few days. Send food through a blender and make sure you take only 1/2 a cup slowly. The pain and vomiting could be triggering your stomach to swell so you want to wait until the swelling is down before you eat regular food again........

Thank you for your reply. That is good advice. I tried that this time and it just kept happening so I did have .5 taken out and am feeling better.

Yes, everyone says that they are much tighter while it's that time of the month.

That is good advice. Try to stay on liquids and soups if you're having trouble. Don't even try solids. Everything is aggravated in there and it will just compound the problem.

Some people are very sensitive to fills and can't handle much of a fill.

Yes I think I am one of those people who are very sensitive to fills. I went down to .7 and I feel good now. I just hope it lasts, and that there is nothing wrong!