Placement of fluid in the band is purposely delayed until four to six weeks after surgery in order to allow the band to “settle in” and the patient to get used to the sensation of having the band in place. Despite the fact that no restriction is added to the band initially, patients may lose weight during the first three weeks. Most patients need a “fill” or band adjustment by the fourth to sixth week after surgery. In most cases, adjustments are made in the office and take just a few minutes. On a rare occasion, the adjustment port is too deep to feel in the office and the patients will need to be adjusted in the radiology department at the hospital under fluoroscopy for the first one or two adjustments.
Band adjustments are made by having the patient lie down on the exam table in the office and “do a sit up” to enable the practitioner to feel the port under the skin and fat of the abdomen. Some patients will have their adjustments while seated in a chair. The port is located and marked, and the skin is prepared with alcohol. Then, a special non-coring needle attached to a syringe filled with a small amount of sterile saline (salt water) is passed through the skin into the port. Patients tell us that adjustments are nearly painless.
Patients must take liquids only for four hours immediately prior to a band adjustment. After band adjustments are made, patients drink liquids for the remainder of the day, pureed food for a day and then back to a soft/regular diet. The average patient loses one to two pounds per week. The first year after surgery, the average patient will get seven band adjustments to maintain weight loss. The second year, an average of one or two adjustments can be expected, and the third year, probably no adjustments will be necessary. Lifelong, patients will need small adjustments to the band from time to time because there is a small amount of saline that will diffuse out of the band system over time.
As a patient, you will be given clear instructions about what constitutes readiness for the next adjustment including diminishing weight loss, ability to eat more at meals, increased hunger, and difficulty following the eating guidelines. You will also be given instructions on what would occur should the band be too tight. Some symptoms include salivation, inability to eat solid food, coughing, and regurgitation of food. Patients who wait too long before their next adjustment have slower weight loss over time because the band is too loose. Patients who have a Band that is overfilled will begin to engage in dysfunctional eating. Dysfunctional eating occurs because patients are unable to eat solid foods therefore eat softer, easier to digest foods that are often high in fat and high in sugar.