The Lap-Band is adjustable, the adjustment is done with a Lap-Band fill , which means that unlike other bariatric surgeries, once it is placed inside you, it can be adjusted to custom, fit your needs as you lose weight. The Lap-Band is adjusted by your surgeon accessing your port, which he or she sewed into your abdomen during surgery. The port is connected by tubing to the band and when your surgeon injects saline solution into the port, it flows through the tubing and inflates the band. Fluid can also be withdrawn and the band will be deflated. This process of adding or removing fluid is called “adjusting” the band, or commonly referred to by patients as “getting a fill.”
The Lap-Band fill is what allows the surgeon to adjust the device to each individual patient…
When the Lap-Band is placed during surgery, it will normally not contain any fluid. Some surgeons do a small Lap-Band fill with a very small amount of fluid so that the patient will have a little restriction from the band at the start. This is a decision unique to your surgeon and there is no absolute right or wrong way. However, most people come out of surgery with an empty band and do not receive a Lap-Band fill until 6 weeks after their operation when they should be fully healed and all swelling from the initial surgery should have subsided.
The reason you need a fill is because the Lap-Band does not work completely on its own. Just being around your stomach does not “make” you lose weight or even have any affect on your sense of hunger and fullness, necessarily. It is only once the band is adjusted properly (which can take one fill or several to achieve) that you will see and feel maximum results from the Lap-Band. It is very important however, not to become overfilled or “too tight” because this will also not lead to successful weight loss and can in fact encourage maladaptive eating patterns and even weight gain.
When you get your first fill, how much fluid your surgeon places, and how often you need more fills will be completely individualized. It will depend on how hungry you are between meals, how much food it takes to satisfy you, and how quickly or slowly you are losing weight. If you are losing weight at a rate of ½ – 2lbs per week and are not hungry between meals, you do not need a fill! If your weight loss is too little and you are constantly hungry, you will probably need one. On the other hand, if your weight loss is too fast or you find yourself not eating enough or eating non-nutritious foods just because they are easier to eat, you probably need an “unfill” – or saline removal. It can take one or many adjustments to find the right level of restriction for you and once you think you’ve found the right place, even the weather or time of month, stress, or any number of factors can change the feeling of how tight your band is.
If you have insurance that covered your Lap-Band surgery then chances are that it will also cover your follow up visits including your Lap-Band fill. If you paid out of pocket for your surgery, then your surgeon should include a set period of time (normally the first 6 months or 1 year) worth of follow up visits with the amount you’ve already paid. If you are concerned about the cost of your fill, have the doctor’s office contact your insurance company. It is possible to be hit with an expensive bill for a band adjustment if you are not aware of how your insurance coverage treats the visits or do not have insurance at all. If you have to pay the cost of a fill yourself, you should expect it to be anywhere from $100 on the low end to $300 on the high end. Sometimes the Lap-Band fill is done under fluoroscopy (a type of x-ray) and thus will be more expensive if not covered by insurance.
Your surgeon will give you instructions about your eating behavior directly after a fill and for the next few days and it’s important to follow them. Some general guidelines that will help ensure your fill is done properly are as follows:
Don’t eat a large dinner the night before your fill and only eat liquids (protein shakes or soup) the morning of your fill. This is because it is vital not to have any food remaining in your stomach pouch when the fill is performed.
Do not drink cold liquids in the hour before your fill because cold can contract the pouch and affect the accuracy of the fill.
Stay around your doctor’s office at least long enough to drink an entire glass of water comfortably and make sure liquid is going down. It is not uncommon to realize you need a little bit of fluid taken out from the Lap-Band fill soon after it is performed.
If you are female, try not to get a fill directly before or during your menstrual cycle (many women report that it will make you feel artificially more restricted than the fill normally will.)
If you have to travel to see your surgeon, stay at least one night in the area in case of any problems requiring the surgeon’s attention.
For the rest of the day after getting your Lap-Band fill, remain on liquid food only. Move to soft food the next day and finally solid food on the third day, just like after surgery, to be gentle on your stomach as it adjusts to the new tightness.
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