The Adjustable Gastric Band System

Adjustable Gastric Band System Developed to aid in long-term weight loss, the Adjustable Gastric Band System has been used by leading laparoscopic surgeons worldwide to overcome severe obesity. Sustained weight loss with the Lap Band is achieved by reducing the capacity of the stomach. The band is a simple silicone ring that is placed around the upper part of the stomach, forming a small gastric pouch to limit and control the amount of food you eat and slow the emptying process from the stomach into the intestines.

Fullness and satisfaction is experienced with just a small amount of food. The reduced food intake results in dramatic weight loss.

The surgery is done laparoscopically (also known as keyhole surgery). A large incision is not required. The stomach area is accessed via four to six very small incisions (1cm) which are then closed with self- dissolving sutures. The recovery time is rapid. Many people are able to resume their regular activities a week or less after their surgery. The operation is performed under general anesthesia and can last between 30 minutes to over an hour.
The Inamed® LAP-BAND® System Patient Book
Adjustable Gastric Banding

Gastric Banding is a variation of gastroplasty, in which the stomach is neither opened nor stapled. It is a process where a band is placed on the outside of the upper stomach, to create an hour glass shaped stomach and to produce a small pouch with a narrow outlet. The special device used to accomplish this is made of implantable silicone rubber and contains an adjustable balloon. This allows us to adjust the function of the band without another operation.
Adjustable Gastric Banding; Some of the advantages of the AGB are:
  • It can be inserted laparoscopically without a large incision.
  • It does not require any opening in the gastrointestinal tract which reduces the risk of infection.
  • There is no staple line to come apart.
  • It is adjustable.
  • It is fully reversible.
  • It is tolerated well by most persons of all ages and physical conditions.
  • There is no mal-absorption or "dumping syndrome."
  • This operation may be particularly suited to persons who are from 50 to 200 pounds overweight.
  • Short hospital stay (around 24 hours)

Although its' effects may not be as profound and rapid as the gastric bypass, the risk of the procedure appears to be less and the recovery time is the shortest. The success rate for satisfactory weight reduction is significant.

Adjustments:

band Adjustments band Adjustments The first 6 weeks after your surgery your band will be empty allowing your stomach to heal and the band to adhere firmly to the stomach. Most people lose weight during this phase but some do not.

Adjustments or fills are painless and take just a few minutes. Some people are actually able to make it to their goal weight with no adjustments but they are the exception rather than the rule. Most patients require 3-5 adjustments over a two year period to reach their goal weight.

Each person is individual; what makes this weight loss method so unique is the ability to adjust the band for each one's specific needs.

HOW DO I KNOW IF I NEED AN ADJUSTMENT?

Your weight loss should average 1-2 pounds a week. We all want immediate results now but banding doesn't work that way. Use Excel to graph out your weight loss so you can actually chart your weight on a weekly basis. Do not weigh more than once a week, you are not going to let the numbers on a scale determine your mood for the day or week. Remember they are just numbers, guidelines of how you are doing but not definitive of success as we all have equally important NSV (non-scale victories) too. If you are following the rules outlined below and still are feeling very hungry or not losing perhaps it is time to consider an adjustment.

Are you drinking a minimum of 70 ounces of water per day?

Actually the recommendation is to take your body weight, divide in half and that is how many ounces of water you need to drink per day to keep your cells flushed and everything in working order. I know it is hard but try using a water bottle with measurements on the side so you can track it. And don't get too far from a bathroom :-) Remember to stop drinking liquids 30 minutes prior to a meal and no drinking during your meal! You want food to fill your newly formed pouch and give you a satiated feeling. Drinking during meals can wash food through the stoma enabling you to eat more than you would if you did not drink while eating.

Are you engaging in some type of physical motion on a daily basis?

I hate the E word exercise because that happens in gym and life does not. So raking your yard, walking your dog, weeding the garden all count as do parking farther from the store, taking the steps instead of the escalator. Many of us former fat people have discovered Yoga, it helps us redefine our physical space as we lose weight which is an essential piece of reclaiming our bodies. Swimming is also a great form of physical activity for those of us with joint problems, and it is something we can do with our children or families. Exercise is cumulative and it all adds up so every little bit counts!.

Are you eating 60 grams of protein per day?

60 grams is not so much really, it is 3 -3 ounces servings per day. Figure your protein at 7 grams per ounce and so 3 ounces of chicken is 21 grams. Once you get the hang of it you become a pro at mentally tallying where you are at for the day. Remember that your body can only absorb about 20 grams at a time so don't over do it. But protein is an essential building block for your tissues and cells and protein helps turn off hunger and carbohydrates seem to turn it on. If you need additional help you might try www.fitday.com. to help you learn to track where you are. And again, we all tend to be a bit OCD about this and our eating so don't worry if you are over or under, just make the adjustments. Letting go of food as a friend is not an easy thing to do but it has not been a good friend. It has betrayed us by making us fat and unhealthy long term and only temporarily satisfies us. Sort of like a bad lover.

Are you staying away from liquid calories?

Cut the slush and mush once you are 4 weeks past surgery, it just goes down way too easy compared to 3 ounces of fish and some broccoli. Are you eating protein and produce and leaving out fast foods and junk? We all have bad days, forgive yourself and just move on, no more guilt. It is possible to eat on the road and have healthful meals, instead of a fast food try a grocery store deli, I had five cocktail shrimp for lunch this week from the grocery store deli and they were healthful, high protein, low fat and I could eat them while I drive (one of my worst habits).

What should I be eating?

Protein and produce, if it isn't one of those two items then it is something that should not be part of your daily diet. Chicken and vegetables, Beef and vegetables, Fish and vegetables, some fruit thrown in there and a little dairy and you are good to go!.

No matter how much fluid you have in your band there are only three kinds of fills, too little, too much and just right, the actual number of cc's is totally irrelevant.

Rules for Adjustments

1) Do not eat 5-6 hours before an adjustment; the whole barium process is more visible on an empty stomach.
2) We prefer fills in the middle of the day as most of us are naturally tight in the morning and loose at night so middle of the day is a good average picture of general restriction.
3) Don't ever let anyone attempt to unsuccessfully access your port more than 3 times! It is the good old three prick rule, if they can't find it in three needle sticks save yourself the frustration of a possible tubing puncture or port damage by leaving - quickly!
4) A single serving size cup of applesauce sometimes gives a better picture of restriction than water because of the viscosity of applesauce.
5) After a fill baby your stomach for 24 hours or more by going back to a soft food diet. Right after a fill is not a good time to push the envelope and see how much you really can eat!

Be patient, sometimes is takes a week or so after a fill to feel full restriction, conversely, some people have edema right after a fill and they may feel overly restricted the first several days. It pays to learn the subtle nuances of your particular physiology and then respect your body by not abusing it after a fill! Remember the amount of fill that each individual can tolerate without side effects is very different but it is a finite number. Keeping this in mind don't always expect your band to be the food police, we must each learn to identify our new feeling of full and respect feeling that by not overeating. Banding should not be enforced bulimia!

Risks Encountered with the Lap Band
Band Slippage
In order for the band to function properly it must be correctly positioned on the stomach.  The band itself doesn’t usually slip, the stomach slips above the band. Slippage can occur for a variety of reasons; over filling resulting in persistent vomiting can be a culprit.  Some slippages, if caught early can be corrected by removing all saline from the band and allowing the stomach to heal and then gradually re-filling to attain restriction.  On occasion a slippage will require re-operation to reposition the band and in extreme cases band removal.   If a band is removed for slippage it generally can be replaced after a healing period to be determined by your Dr...

Band Erosion
Erosion is a rare complication more specific to some of the older design of bands.  It is characterized by the stomach tissue over-growing around the band until the band is on the inside of the stomach instead of the outside.  Erosion almost always necessitates band removal although it rarely is a life threatening situation.

Hardware difficulties
Ports have been broken and tubing punctured usually during the filling process and this risk is diminished by using experienced fill practioners and using fluoroscopy to locate the port.  However, broken ports and punctured tubing are relatively simple matters to fix although frustrating for the patient.

Infection
With any surgical procedure or adjustment there is always the slight risk of infection.  Infections can usually be treated with antibiotics and in rare cases may necessitate further medical intervention.   Always make sure you are in top health prior to your surgery or adjustments without colds or drugs that may compromise your immune system. Notify your Dr. immediately if you suspect you may have an infection of any type.

Stretched Pouch
This is a complication that can be completely avoided by not overeating.   Learn to stop eating the moment you feel satisfied.  Continuously packing food into your stomach when full will cause it to stretch and food may back up into your esophagus causing you future discomfort and problems.

Reflux
Reflux is frequently associated with a too tight band causing stomach fluids to back up into the esophagus and damage the delicate tissues not designed to be bathed in caustic stomach juices.  If you are experiencing mild reflux talk to your Dr. about preventative measures such as diet changes or medications.   If your reflux is a persistent problem speak to your Dr. immediately, don’t complicate the issue by waiting hoping it will get better without intervention.
 
How does the Band Work:

View Flash Video to see how the procedure works. Video requires Macromedia Flash and Quicktime.

Lap-Band® Installation Video.

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Lap-Band® Installation Video.

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Lap-Band® Adjustment Video.

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