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Gastric Band Adjustments are made by accessing the port (which implanted under the skin) with a special needle inserted through the skin in the office setting. When the gastric band is inserted, the band is not filled, but we attempt to get the air out of the system. In order to minimize the chance of band slip, the patient is on liquids and progressively soft foods for a month so that the band will heal in before the patient loads food on it. The patient is eating solid food, usually without restriction, by the time of the first fill, about 6 to 8 weeks after surgery. Some patients will have some baseline restriction. Most bands are progressively adjusted in a fairly typical sequence to a certain point where if it is made any tighter, the patient would not be able to eat solid food.
- Note that with gastric banding is that with proper eating habits, hunger is curbed, not alleviated.
- Understanding the anatomy and the mechanics of the way the band works and eating with certain concepts and strategies is absolutely necessary for success.
- A tighter band does not necessarily mean more weight loss. Patients naturally think that having a tighter band will lead to faster weight loss or absolutely take a way their hunger.
- A properly adjusted band and working successfully with good strategies of eating are what are going to produce weight loss.
- A band that is too tight, accompanied by regular vomiting or managing to overeat on top of a tight band will lead to a band slip / prolapse or to an erosion. The band will then have to be revised or removed. Appropriate follow-up with the surgeon, patient compliance, and careful adjustment of the band can help avoid such problems.
- Patients absolutely have to let us know if they are vomiting, develop heartburn, or cannot eat solid food.
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Using x-rays for Band Fills
Our program uses fluoroscopy to adjust the gastric band. Fluoroscopy is a motion picture x-ray. The patient drinks a swallow of barium and the esophagus, the stomach and the band can be seen. We can do fluoroscopic fills in our Weight Loss Center Clinic. Dr. Fermelia and the patient can see if there are complications (such as esophagus dilation or band slip). We can see how tight the band is and do a custom fill with the intention of making sure that it is not too tight.
Most bands worldwide are adjusted without fluoroscopy or x-rays, but more and more programs and surgeons are using “fluoro”. Fluoroscopy does not guarantee a perfectly adjusted band. It can still be too tight. We can still under fill the band. But we feel we can get closer. Without an x-ray, filling the band is an educated guess.
The role of the patient in band fills
Fluoroscopic fills are actually done with a lot of clinical information from the patient. This information is as important as the images. The patient will be asked a number of questions about what you can eat, portion sizes, hunger and other things. It is very important that you are very honest with your answers. Remember if your band is too tight for too long, you may end up having to have it removed or have another operation.
Our patients find it very helpful for the patient to see their own band. Patients can see that the band is properly adjusted and be reassured there are no complications.
The problem with fluoroscopy
Fluoroscopy is expensive. Most insurance plans cover the cost, but there is a possibility that your insurance company does not. We have worked with most insurance plans in the area. We probably can tell you if your insurance company is likely to cover your fluoroscopy and band fills.
Proper Adjustment
Band adjustment is a partnership between the surgeon and the patient. We talk about the “green zone” concept to adjust bands. We find it a great way to figure out when you might need another fill or to recognize if you are too tight.
- How to be successful with a band
(Click here for a copy of How to be Successful with a band)
Dr Fermelia's tips on understanding and success with the band.
Stretch receptors. Understand that the gastric band works because it creates a small (approximately 4oz.) stomach pouch above the band. Stretch receptors in the pouch to tell the brain that you are full. Gastric distention creates a neural and hormonal signal to the brain of satiety (satisfaction, the opposite of hunger).
The pace of eating. This communication between the brain and the stomach takes several minutes, so we counsel patients to eat slowly (more than 15 minutes) and they will eat less. The slow pace of eating is important.
Solid food. The most important idea is to eat solid, dense food. This is what will stimulate the stretch receptors in the pouch and help you to feel full with a small amount of food. If you eat mushy or liquid calories, they will go quickly into the lower stomach and you will not feel full for long. Pressure in the pouch over time is what stimulates the stretch receptors. Studies show that is the pressure in the stomach wall of the pouch that creates the sense of fullness. Dense food stays in the pouch. Everything you eat should be solid and dense. Mushy foods are called “slider foods” because they slide right out of the pouch. You will feel unsatisfied all day. You will be hungry all the time.
Protein. Protein is the best food while losing or maintaining weight loss. Fat has about twice the calories per gram compared to protein and carbohydrates. Protein intake is going to minimize the loss of lean body mass (muscle) during the weight loss you will experience. Choose low fat proteins. Have protein with every meal. Eat protein first. Fill up on protein. Eat your entire protein portion completely before moving to other foods. Most people are overweight because they eat too many carbohydrates: simple sugars (sweets) or starches (bread, pasta, potatoes, etc.). The pouch will not let you overeat carbohydrates.
Eat only 3 times a day. If you follow these ideas, you will feel satisfied between meals. Our philosophy is that you should not just eat “when you are hungry”. If you eat regularly you will not feel deprived and you will not get over hungry and throw all these ideas away. “No calories between meals” should be your policy.
The sequence of eating. Eat dense low fat protein with every meal. Every meal, including breakfast. Then eat vegetables and fruits. Then and only then, eat carbohydrates. The order of the food you eat is important.
Don’t wash out your pouch. We need pouch distention pressure over time to help you to feel full. You want to feel full for hours, until your next meal. Don’t drink with your meals. If you drink with your meals it is like eating mushy food. The food will move out of the pouch and you will soon be hungry. If you drink right after your meals you will wash the food out of the pouch and you will soon be hungry. We recommend waiting 30 to 60 minutes after meals. Between meals you should drink large quantities of NON calorie beverages.
Healthy food. You know what you should be eating. Since you are not going to get a lot of calories, they have to give you all the nutrients you need. Plan your meals. Have good choices available. If you are eating on the run, you are going to make bad choices. Don’t settle on eating the “healthiest thing” you can find at the fast food restaurant. Eating right for a lifetime is an effort, but your lifelong success is worth it.
How to fail: Do you want to know how you fail weight loss surgery? Eat mushy or liquid unhealthy high calorie foods all day. That’s how all the people you have encountered that have had unsuccessful weight loss surgery did it. |
Success is a combination of anatomy (which we give you in the operating room and during the fill) and behavior. We will help you as much as we can with the behavior, but you have to be self motivated to stick to it and find what works for you while using these ideas. Consider that this needs to be a way of living, not a diet. This is how you are supposed to eat. It is how we should all eat. Keep a positive attitude. Lean on us if you need to. |
Rules to Live by:
- Eat only three meals a day.
- Do not snack or “graze” between meals. A good rule: NO CALORIES BETWEEN MEALS
- Eat only solid food. Avoid soft, mushy, or liquid foods.
- Each meal should be low in fat and contain protein.
- Eat protein first followed by fruits and vegetables. Fill up on protein, you should eat very few simple or complex carbohydrates.
- Eat slowly. A meal should be eaten in 20 to 30 minutes.
- Eat only nutritious food. Plan your meals and don't eat on the run. Take healthy food with you.
- Stop eating when you feel satisfied (slightly full).
- Limit fats, sweets, alcohol and carbohydrates.
- Do not drink anything during, or 30 to 60 minutes after a meal.
- Do not drink liquid calories in any form.
- Exercise for at least 30 minutes each day emphasizing muscle-building resistance training.
Click here for a copy of Rules to Live by. |
This program is designed and was conceived to benefit the people of Wyoming, with our unique circumstances: large traveling distances, small populations, weather