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Band Assessment Clinic
Placement of the band is just the first step in the process towards safely losing weight with the band system. At the time of surgery, no fluid is added to the band.
There are typically no adjustments done during the first two months so that the band can heal well in its position at the upper stomach. There is always some degree of swelling at the time of band placement, and it usually takes a month or two to fully settle down. It is important to ensure that the band heals appropriately in its final location.
Schedule of Assessments (adjustments)
You can schedule your first adjustment in the band assessment clinic 8 weeks after surgery. Please make sure that you are confirmed in a clinic with a provider who does band assessments and adjustments as a routine. This and all subsequent band fills are performed in our band assessment clinic, which is a clinic designed just for band patients.
1-4 weeks after surgery
This first appointment is scheduled to make sure that you are recovering well from the stress of surgery and that all of your incisions are healing well. We do not perform an adjustment at this visit.
2 months after surgery
Your first adjustment is performed approximately two months after your surgery in the clinic. This visit takes about 15 minutes with the surgical team. There may or may not be x-rays associated with this first adjustment: If you had an upper GI study (barium swallow with video x-ray) preoperatively AND your surgery team obtained postoperative films to document band position immediately after surgery, then you will need no x-ray tests associated with this first assessment and fill visit. If you haven't had an x-ray to document band position yet, then you will have a barium swallow with video x-ray to show the exact position of the band and then the first adjustment will be done in the clinic.
3 to 12 months after surgery
During your first year following surgery, subsequent band assessment appointments are completed in the clinic every two to four weeks initially and then these appointments are spaced out to every 4 to 8 weeks when satiety control and weight loss are being achieved reliably. We anticipate that most patients will need about 10 visits postoperatively in the first year in order to achieve good initial control of hunger (satiety) and weight loss.
Beyond 12 months
Normally, this phase of postoperative care involves assessments every 6 months for the rest of life. Some patients who had a lot of weight to lose may need to be seen more frequently during the second year after surgery and then the visits will be spread out once weight loss becomes more stable. A small amount of fluid always leaks out of the band because of osmosis and so even though you may have good symptom control after one fill, you may need additional saline added after 6 months to return to satiety control. An upper GI study (video barium meal) and laboratory data will be obtained annually in order to make sure the esophagus and stomach are appropriately-sized and there are nutritional deficiencies developing.
How do the assessments work?
Our goal at assessment is to evaluate for weight loss and symptoms of hunger suppression. Please review the adjustment chart by clicking here to see how we use your weight loss and symptoms to decide if an adjustment is needed or not. The band at all times is too loose, too tight, or just right.
Too Loose
When the band is too loose, you will experience frequent hunger, looking for food, eating bigger portions, and slow or no weight loss.
Just Right
The band is just right and in the target zone when you are not hungry between meals, when you are not looking for food or constantly thinking about food, and when your weight loss is about 1-2 pounds per week in the first 12 months after surgery.
Too Tight
When the band is too tight, you may have vomiting, reflux, a night cough, or develop maladaptive eating (chocolate, ice cream, and other calorie-laden liquids) in order to pass food through the tight band.
How is the adjustment performed?
Locating the port
The port is positioned under the longest incision. Most patients will find their port about halfway between the breastbone and the belly button just to the left of the middle. The port can typically be felt without any aids. For the first few adjustments the port may be easier to find when you are lying down and lifting your head off the procedure bed. This tightens up the muscles under the port and pushes the port closer to the skin. We will almost always ask you to tighten up your abdominal muscles by lifting your head or upper chest for the adjustment. We will also usually ask you to have a pillow positioned under the small of your back because this pushes your port closer to the skin. There are also other ways to find the port by using a simple handheld electronic device (a "stud finder") or by using x-ray guidance, but these methods are not usually needed.
Saline insertion or removal
The amount of saline that is added or removed from the port is typically decided upon after discussing your symptoms and weight loss with you. For the first adjustment, a larger amount of fluid is usually added (4cc typically) and subsequent adjustments are performed in increments of 1cc to a total of about 9 or 10cc. Patients who have come quite close to the right fit may have smaller increments of saline added in order to obtain better satiety control without risking obstruction. There are some patients who are perfectly well adjusted at just 4cc of fluid and some who may need up to 10cc of fluid.
A syringe is pre-loaded with the correct amount of fluid to be added. The skin overlying the port is sterilized with an alcohol wipe pad and a 20 gauge non-coring needle (a Huber needle) is passed through the skin and into the port. Entry into the port is confirmed by feeling the titanium bottom on the backside of the port and by aspirating saline from a previous adjustment. For first adjustments we add the first amount of fluid and then we can remove this same fluid to confirm position.
Assessing band for obstruction
Occasionally the adjustable band may become obstructed. In almost all settings, this can be picked up by asking each patient to drink a small amount of water to make sure that at minimum liquids can pass through the band opening after an adjustment.
Schedule next appointment
It is very important that each patient schedules a subsequent visit in the band assessment clinic after a visit. At minimum all patients should always have a follow-up visit within the next 6 months for the rest of life.
Labs and X-rays
We typically obtain laboratory data 3 months after surgery and then annually on the anniversary of surgery. Even though adjustable band surgery does not bypass the stomach or duodenum, there can be pre-existing vitamin deficiencies or developing vitamin deficiencies because of the more restricted amount of vitamins available in your more restricted volume diet.
We assess the band for position once after surgery and this is in the form of either an x-ray performed while you are in the hospital or as a barium swallow (upper GI) with video obtained before your first adjustment. At your anniversary of surgery and annually we will typically obtain a routine follow-up barium swallow with video. If you experience heartburn, abdominal pain, or other abnormal symptoms we will also obtain a barium swallow in order to assess the position of your band and the size of your pouch above the band.
If your laparoscopic adjustable gastric band procedure was done elsewhere
If you had your laparoscopic adjustable gastric band procedure performed by surgeons not in the University of Minnesota Physicians (UMPhysicians) group and wish to have follow-up care, please note the following:
-You must have an upper gastrointestinal (UGI) fluoroscopic x-ray (barium swallow with video) in our hospital before your surgical consultation. This can be scheduled after discussing your case with one of our nurse coordinators. You will be required to have an annual barium swallow if you want to continue to have assessments under our care.
-Your evaluation for adjustments will then start with a standard surgery consultation with one of our surgeons. We must have the name of your primary care provider in order to do this consultation.
-You must complete a full weight loss surgery questionnaire [link this] before your first clinic appointment to ensure that we have a complete health history on file.
-Provide a copy of the operative report and all progress or procedure notes related to previous band assessments and fills.
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