Problems following a Fill (Adjustment)

Most patients undergo surgery and recover without incident. A couple of my patients decided they could eat substantial food earlier than was advised, resulting in chest discomfort and regurgitation of the food they had just consumed. However, the majority of patients meticulously adhere to our recommendations and experience few, if any, issues until they receive their first adjustment. Even so, the majority of patients are able to modify their dietary behavior to accommodate the band's restriction.

However, there are those who struggle greatly to alter their eating behaviors. The result is unpleasant for patients who have difficulty with solid diets after adjusting to the band. While this is not in and of itself a violation of the AGB, allowing it to persist can lead to additional complications.

When you regurgitate food or liquid, there is a chance that some of it will enter your trachea or windpipe. This is known as aspiration, and it can lead to coughing fits and even pneumonia. Particularly susceptible to aspiration are patients who attempt to eat while lying down or who lie down immediately after eating. Occasionally, the problem is caused by the band being too tight, but the majority of the time it is because the patient is eating too quickly, taking too large of bites, not chewing adequately, or not halting when they first feel full. If the issue becomes severe enough to cause pneumonia, the solution is to remove the fluid from the band and leave it out for a few weeks. The procedure of gradually expanding the band can then be repeated.

Some patients are so enthusiastic about weight loss that they desire an ever-tighter band. When the restriction reaches a certain stage, only liquids will be allowed to be consumed. Eventually, even liquids may be difficult to pass, and the patient will rapidly become dehydrated. This is a potentially grave circumstance. Our bodies can survive without sustenance for extended periods, but only a few days without water. When a patient reports that they cannot keep anything, including water, down, the band is too restrictive. The solution to this problem is to remove enough fluid from the band to prevent it from expanding.

enable liquids to easily pass through. The patient should also be able to consume solid foods, so long as they are "small bites, chewed well, and eaten slowly." (Sounds like a shattered record, doesn't it?)

Difficulties at the Port

The injection port can be inserted in a variety of locations during surgery. I prefer to position it along the patient's left abdominal side, close to one of the small incision sites used to insert a laparoscopic canula. To prevent the port from migrating, it is sutured to the surface of the abdominal muscle layer.

Despite this procedure, it is possible for the sutures holding the port in place to break over time. If this occurs, the port may actually turn over, making it impossible to access with a needle as usual. Occasionally, it may be possible to manually rotate the port, but fluoroscopy (X-ray) may be required to visualize it. If the port rolls over, it is typically necessary to return to the operating room to reposition and secure the port to the muscle.

The cause of some locations' reversal is poorly understood. It may be the result of excessive tension on the sutures or extreme elongation of the attached muscles. This however occurs infrequently and is typically straightforward to resolve. One patient's port did turn, and after the resewing procedure, he developed an infection around the port. Ultimately, a new port inserted in a new location was necessary to eliminate the infection in his case.

After an adjustment, it is also possible for the port to release some of the salt solution. If the correct needle is utilized, this is highly unlikely, as the silicone interior of the port typically seals itself completely when the needle is removed. Even if the correct, noncoring needle is used or if any part of the port other than the silicone core is punctured, a discharge may occur. The port housing is comprised of durable plastic and cannot be punctured by a needle. However, the needle can pierce the stem of the port, and that portion of the port will not secure itself, resulting in a slow leak.

One of the signs of a breach is that the restriction seems to lessen significantly in a matter of days. When the port is accessed again

It contains less liquid than anticipated. A leaky port requires replacement. This requires an ambulatory surgical procedure, but neither re-entering the abdomen nor replacement of the band is necessary.

On rare occasions, fluid can seep out of the system through the tubing between the band and the port. If this occurs, the connection between the two system components may have become disconnected. To correct this, a second laparoscopic operation must be performed to locate and reconnect the two separated extremities. Again, there would be no need to replace the ensemble.

The band must be replaced if the balloon portion that regulates the size of the stomach opening leaks. The most probable causes of a band leak are an unnoticed tear or puncture of the balloon during insertion or material fatigue, which can occur over time. Fortunately, this is an extremely rare occurrence. In order to prevent the placement of defective bands, the surgeon tests each band prior to insertion to ensure that it does not escape.

Delayed Issues with the Group

Slippage is the most prevalent significant complication encountered with the AGB. This device is being placed around a structure created by God, and it does not always remain precisely where it was initially placed. Even though the band is sutured to the stomach, it is still possible for the band to slide. The band is capable of ascending onto the esophagus. Nevertheless, if the band is going to slide, it typically slips downward.

Typically, the term "slipped band" refers to one of two situations that are similar but not identical. A true "slip" occurs when the sutures holding the stomach over the band fail or separate. The most common cause of this slip is excessive overeating, which causes progressive expansion of the upper pouch. If the band slides down on the stomach, the pouch will continue to expand, allowing the patient to consume additional food, which will exacerbate the problem.

The most frequent symptom of a slipped band is indigestion. When the band is adequately positioned, the small stomach pouch above the band produces negligible amounts of acid. As the band descends, not only does the stomach cavity expand, but so does the amount of acid produced above the band. The band impedes the passage of everything, including stomach acid, causing it to reflux into the esophagus and cause heartburn. This symptom can typically be alleviated with an acid-reducing medication, but the loose band must ultimately be addressed.

If the surgeon suspects a displaced band, he or she will likely order an upper gastrointestinal X-ray to determine the nature of the problem. The patient ingests liquid barium contrast, which enables the anatomy of the esophagus, stomach, and band to be defined. The presence of an upper stomach pouch that is larger than normal is conclusive evidence that the band has slid. If the slip appears to be relatively minor, it may be managed by deflating the band and then gently reinflating it. This may or may not

work as a long-term solution, but it is usually worthwhile to attempt because the alternative is typically another operation.

Gastric herniation is another condition commonly grouped with "slipped band" because the symptoms are comparable. Nonetheless, this issue does not entail actual band movement. In a gastric hernia, a portion of the stomach from below the band protrudes through the orifice in the band. This is a potentially graver issue, as the portion of the stomach that is herniated through the band could have its blood supply cut off. This causes excruciating agony and, if left untreated, can even result in the death of the affected portion of the stomach, with catastrophic consequences.

The initial step in the treatment of a suspected gastric hernia is the evacuation of all fluid from the band to reduce constriction around the herniated portion of the stomach. An upper GI X-ray is used to document the issue, but sometimes the barium contrast never reaches the herniated portion of the stomach, so it may not be visible on the X-ray. Endoscopy can be used to examine the interior of the stomach, but it may or may not yield additional information. Ultimately, if a gastric hernia is confirmed or strongly suspected, the patient will require a laparoscopic procedure to correct the issue.

The actual operative management of a displaced band or gastric herniation is partially determined by the surgeon's findings during surgery. In both instances, the options may include resuturing the stomach over the band, repositioning the band, or removing the band entirely and possibly conducting a different bariatric procedure. If the band is merely removed, the patient is highly likely to regain most, if not all, of their previous weight.

Virginia's Story

Before surgery, Virginia weighed 242 pounds.

Virginia, two years post-op, weighs 154 pounds.

Like most people, I have attempted every diet. I weighed 242 pounds and stood 5 feet 1 inch tall. I carried the majority of my weight below my waist, but my face and limbs were swollen. I arrived at the conclusion that surgery was the only remaining option. I had a heart condition, diabetes type 2, aching joints, and breast cancer. In fact, I had several other severe issues that required surgical treatment, and I believe they were all related to my obesity, including the cancer.

In October of 2003, I joined Dr. Sewell's ensemble. He had performed my mastectomy to treat breast cancer, so when I learned he was in the band, I didn't hesitate to join. Two years later, I've lost 88 pounds and now weigh 154 pounds. I've never weighed less than 149.

Soon after the band surgery, I ceased taking my diabetes medication, and I am now in remission. I also frequently wheezed, as if I had asthma.

My pulmonologist stated that my respiratory difficulties were caused by my heart, which was weak due to chemotherapy. Nevertheless, the wheezing stopped immediately after the band surgery. In all honesty, I did not anticipate achieving the results I did.

I lost 70 pounds in the first six months of my diet. And it was very straightforward. I discovered that as my weight loss increased, so did my motivation. I was losing weight so rapidly that I felt increasingly better mentally. Even if it isn't strenuous, exercise is extremely essential. I have walked approximately one mile every other day since the outset. There is a rush of adrenaline when you first lose. But as the weight loss slowed, my complacency increased. I forgot I was overweight and now consider myself to be a typical person.

Seven months after receiving the band, I observed I was no longer hungry. Then I developed kidney problems and had to have one removed. When attempting to remove my kidney, the nephrosurgeon reported having difficulty working around the catheter. But after having my kidney removed, I had an enormous appetite. So I received a second fill, and I believe it was too tight.

I sensed something was wrong when my indigestion was so severe. I believed I had gastritis. I endured pain throughout the entire summer, slept sitting up, and was ultimately diagnosed with a slipped band via X-ray. Dr. Sewell added less fill to my band, which has been beneficial. The slip will need to be treated, and Dr. Sewell is scheduled to reposition my band. I just haven't done it yet.

Regardless, I am certain that I brought this upon myself. I overate, followed by excessive vomiting. I am aware that if the band is too tight or I overeat, vomiting can cause the band to slide.

I am aware that I must manage my disease for the remainder of my existence. I cannot guarantee that I will not have diabetes tomorrow. That doesn't work. Even though it is currently in remission, I must remain vigilant and monitor my condition. It is the same with gluttony.

I have a propensity to become discouraged until I recall my previous appearance. When I view these images, I feel fairly decent. However, after the kidney

When my band loosened after surgery, I gained a few pounds and became extremely frustrated with myself. I began to feel a sense of déjà vu, as if I were reliving the old diet days. However, this is distinct. I've gained a few pounds, but I haven't regained everything plus 20 pounds like I used to. I'd like to be between 125 and 135 pounds, but I'll have to adjust to being in the 150s. And I'm pleased with that when I look at old photographs.