How much fill did your dr put in on the first fill? I am getting mine today and he plans to do 1 cc. I'm thinking of asking for 1.5 I have had no restriction and can eat anything. Is that too much too fast?

I got 1 cc the first go round. You will probably want to take it slow until they get the right amount but too much could just cause problems. Let the doctor be the doctor instead of you trying.

Yes, you are right. I am just a little over enthusiastic and excited to finally be getting a fill.

I will let them do their job and let the band do its job. My job is Water, tiny bites, good food choices, and chew, chew, chew. I think that's enough to do. I won't try and play doctor anymore!

Dr. Schmit gave me 1 cc the first fill and 1 cc the second time. He likes to sneak up on it so you don't get too tight. That isn't good either. You will probably notice a little restriction with the first fill and even more the second time. I think I have good restriction right now. I hope this is it, I really am hoping and praying...

I got 2cc in a 4cc band the first fill, and had to go back for an unfill!! But he only took out .4cc, leaving me with a first fill of 1.6cc. I DEFINATELY have restriction.

Good luck! Let us know!

my first fill was also 1cc in a 4cc band. i returned 2 weeks later for another .5cc, not the sweet spot but I have been losing since..

First of all, you have to individualize for each patient. I start by asking a few questions. Are you vomiting? Do you have restriction? How long until you get hungry? ARE YOU LOSING WEIGHT?

If you are losing 1-2 pounds a week, I will be reluctant to do a fill, since you are doing fine with weight loss. For patients who are not losing weight, I will do a fill unless they are vomiting frequently or are significantly restricted. Then we will explore why they are not losing; are you exercising? eating the wrong foods? Drinking liquids with calories?

Assuming that you are not losing weight, are not vomiting, and not restricted, this is how I do fills: First fill for 4 cc band: 1 to 1.5 cc depending on whether or not there is any restriction at all. Subsequent fills are about 0.5 cc until we reach 2 ml. After that I go very slow, about 0.25 cc per fill. I have no patients with "full" bands. The highest I have gone is 3.1 ml.

For VG or Vanguard bands double all the numbers listed above.

I REALLY like to avoid overfilling bands, as it leads to problems. Currently there is no data showing an advantage for fluoroscopy adjustments. Slow and steady is safe and works.

Hope that helps.

Mark Pleatman MD

www.laparoscopy.com/pleatman

Dr. Pleatman,

I was told the advantage to the fluoroscopy is to make sure the band is ok and not leaking. Is this not an important safe guard for your patients?

I was also told that there's no advantage w/ or w/o fluoro. At Dr. Ortiz's office they use fluoro & they can see the band. At my Long Island fill office, she doesn't use fluoro, hits the port every time on the first stick & prefers smaller fills. When I was overfilled, she sent me for a barium swallow, saw the film, saw the band was o.k. & unfilled some. Apparently, if there's a leak, it's pretty obvious & again, can be confirmed by x-ray w/barium. Maybe Dr. Pleatman can clarify...does that sound right to you?

One reason to use fluoroscopy is if you are having trouble accessing the port, but that is pretty rare. The other reason cited by those who do is to give a bigger fill. What they do is fill the band too tight, then give barium by mouth and watch it go down. They then start to empty the band to the point where the barium starts to go through. This way they can get to the ideal fill volume with less tries. This might be a good idea if you are flying to Mexico to have your fill, but it turns out that it still doesn't work that well. You can still get it too tight or too loose with this method. Besides, fluoroscopy generally requires an expensive visit to the hospital where the xray machine is.

You don't need fluoroscopy to see if there is a leak, because we always empty the band with each fill, checking to see that everything we put in last time is still there now. I've never seen a slow leak. If there is any leak at all the band will be empty.

The world's foremost authority on LapBand is Paul Obrien (from Australia). He doesn't use fluoroscopy. He just does small fills incrementally until the band is just right. That works for me too.

Mark Pleatman MD

www.laparoscopy.com/pleatman

2 cc in a 4 cc band

I had 2 ccs in my 4 cc band. She imediately took out 1cc. I had to go back for another unfil a few days later.

I have a fill appointment Monday morning.