How Much Fill Is Required?

The key to the band's effectiveness as a weight-loss instrument is creating restriction without obstruction. If the band is too restrictive, the patient may experience difficulty swallowing even liquids. If it is too lax, the patient will consume an excessive amount of food. So, what is the proper quantity? Honestly, each patient is unique. Should you have one significant adjustment or multiple small adjustments? Even among surgeons who perform these procedures on a regular basis, there is substantial disagreement on these points. There are compelling arguments for a diversity of adjustment styles.

According to some surgeons, the most effective method to adjust the band is to tighten it to a predetermined size. Fluoroscopy is required to observe the adjustment procedure while the patient swallows X-ray contrast material. It is possible to see the contrast material passing through the banded aperture. The amount of fluid within the band is then adjusted precisely to produce the desired size opening. This type of adjustment is significantly more expensive due to the use of fluoroscopy; it is sometimes referred to as a "adjustment under fluoro." In addition, because the procedure entails X-ray imaging, many surgeons delegate the adjustment to a radiologist instead of performing it themselves.

The disadvantage of fluoroscopy, in which the band is tightened simultaneously, is that the majority of patients have significant difficulty swallowing. In other words, they are compelled to make drastic dietary modifications without adequate preparation. It is difficult to abruptly slow down, take small bites, and stop eating when you have been eating in a particular manner for many years. Old behaviors, especially the automatic act of eating, die very slowly. Even the most motivated patients frequently find it difficult to adjust to a sudden and significant change in how they feel whenever they attempt to consume.

Some patients utilize a return to a liquid diet as a means of coping with this abrupt issue. However, this obviously defeats the purpose of the ensemble. However, when patients believe they are famished, and

Since everything they consume is regurgitated, they will consume whatever they can keep down. This includes condensed soups, ice cream, chocolate, and other liquids that are high in calories. This can predictably result in weight loss failure, protein deficiency, and even despondency.

Some individuals struggle to the point where they are forced to consume only liquids. Multiple smaller saline injections over a period of time constitute an alternate method for adjusting the band. Typically, these modifications are performed in the surgeon's office without the need for fluoroscopy. By gradually adding fluid to the band over the course of several weeks or even months, the patient can modify their eating patterns in smaller increments. Typically, multiple adjustments of this type are required to obtain the same degree of tightness as one fluoroscopic adjustment. However, patients spend less time vomiting up and resort to high-calorie liquid foods less frequently. Early on, however, patients are still able to consume food relatively ordinarily, so their weight loss is frequently slower than anticipated.

Either method for altering the band can be used effectively so long as the patient is informed of what to expect. Personal preference is the gradual approach, with adjustments made every two or three weeks at most. I usually begin with an initial adjustment of 1.5 milliliters for patients with a standard 4 ml band, or 5 milliliters for those with a larger band. Two weeks after each adjustment, the patient returns to the office to be weighed. They then meet with the dietitian to discuss their altered dietary patterns. If their weight begins to plateau or if they are not experiencing much restriction, I will add 0.2 to 0.3 milliliters if the band is standard, or 0.5 to 1.0 milliliters if the band is larger.

Some patients are surprisingly sensitive to even minor adjustments to their band. With a minor change in the volume of fluid in the band, it is possible to go from experiencing minimal restriction to being unable to keep anything down. Immediately after each adjustment, I have each patient drink 1 or 2 ounces of liquid to ensure that they can still ingest. Despite passing this ritual, I will occasionally have a

Within 24 to 48 hours, the patient returns complaining that they can't keep anything down, and I must remove some of the fluid.

The band, the tubing, and the receptacle constitute a closed system, so once fluid has been injected into this system, it remains until it is removed. Occasionally, a small amount of air can become caught in the port or the tubing, occupying a small volume. As fluid is introduced to the system during the initial adjustment, this air is flushed into the balloon portion of the band. Here, the Silastic membrane permits air to gently escape from the system. The result is a progressive loss of restriction, and patients report that they felt much tighter immediately after the adjustment, but that it seemed to loosen up again a few weeks later. When a second adjustment is made, the quantity of fluid in the band is lower than anticipated. When this occurs, it was only air that seeped out, not the salt solution.

Joyce's Tale

I've been overweight since I was a child of five years old. At the age of 16, I visited a diet specialist, took pills and received shots, and dropped to a size 9. I recall consuming everything, yet losing weight. It took me a year to lose the weight back then, but I couldn't take the pills indefinitely. It took me only six months to regain the weight once I stopped dieting.

When I had gallbladder surgery two years ago, my height and weight of 4 feet 11 inches and 250 pounds made me too large for laparoscopic surgery. My doctor informed my sibling and family that I would never reach the age of 80, despite the fact that my mother had just turned 80. I'm 56.

I had numerous health issues, including high blood pressure, high cholesterol, and diabetes. Diabetes runs in my family, so it was inevitable that I would develop it.

I had read about the band, met with Dr. Sewell, and decided in April of 2005 to undergo surgery. I began at 244 pounds and a BMI of 48. Before the surgery, I was so exhausted that I could not make it halfway through the store. I would waddle rather than stroll.

Now, approximately one and a half years later, I weigh 180 pounds and have a BMI of 36.4.

My greatest obstacle is bread. I can consume it, but it is coarse, so I avoid it despite the fact that I miss it greatly. I also avoid beverages, of which I previously consumed six to eight per day. Eggs are sometimes difficult for me to digest, but I enjoy pasta.

I have probably not been as strict with myself as I should have been. I figure that it took me this long to gain this weight, so if it takes me some time to lose it, that's fine. As a result, I have not strictly monitored my diet.

In addition, I've increased my physical activity. I go to a health club where I walk on a treadmill and perform water aerobics. Exercise makes me feel better. And I observe a significant shift in my vitality level. I've been ballroom dancing for approximately 30 years, and now I'm able to do much more and enjoy it more. Previously, two or three dances would leave me exhausted. Now I can dance the entire night away. However, I will have to start searching for new gowns as my old ones are becoming too large.

I am still taking medication for Type 2 diabetes, but my blood pressure has decreased significantly and I believe I will soon be able to stop taking it.

I will be paying for the surgery for the next decade, but I have no regrets. I must consider myself fortunate, as many individuals who join the band must do so on their own. My insurance at least partially covered it. In particular, since I've gone from a size 22 to a size 16, I've realized significant savings on food and apparel.

There have been several problems. At one point, I suspected that my port had a leak because I felt restricted after my last infusion, and then abruptly I did not. When he checked the fill, I should have had 3.3ccs but only had 3.0. He refilled it and asked me to return in a couple of weeks to be examined. When I returned, the restriction was still present and the fill was at 3.3ccs, so there was no escape. If there was a breach, it would have

Dr. Sewell would perform day surgery to remove the previous port and replace it with a new one.

Since losing weight, my port has migrated. Now, it reaches my waistband. Due to the fact that I have a sedentary job, the placement of the port is sometimes problematic, and I've discussed relocating it with Dr. Sewell.

If I could give anyone contemplating forming a band any advice, it would be to go for it. I would not have contemplated the gastric bypass because I believe it is too risky. There is risk in everything you do, but the danger was too great for me. With the ensemble, I was willing to take risks. And I've heard too many accounts of gastric bypass patients regaining their weight, with some patients opting for a band in addition to their bypass.

I would also recommend joining a support group. I enrolled in Dr. Sewell's program's two-year support plan with the psychologist. I am a member of both an online community and Dr. Sewell's band support group. I find the live support group to be extremely beneficial, and I enjoy it a great deal.