ObesityHelp

How the Lap-Band actually works, fills and refills

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This may help you in understanding the restrictive mechanism of a Lap-Band.

The ALLERGAN protocol for Lap-Band fills calls for a six-week delay after surgery, prior to any fills. The purpose for the six-week delay is for the patient’s stomach to heal from the surgery, as well as allowing time for the Lap-Band to “Seat” or “Nestle” into the fat pad between the stomach wall and the interior wall of the Lap-Band.

Prior to receiving an EFFECTIVE fill, it is VERY uncommon to have any restriction from a Lap-Band. Some patients will NOT lose weight, or may even GAIN weight until they have received an effective fill in their Lap-Band.

Normal weight loss with a properly restricted Lap-Band is between 1 and 2 pounds per week.

The normal cycle of fills, restriction and weight loss is as follows:

1. The patient's Lap-Band constricts when the patient receives a fill. Swelling for a few days after receiving a fill is very common. Many doctors require a patient to go on a liquid diet for a day or two after receiving a fill. A fill may have a “Delayed Action” of up to 4 weeks. A “Delayed-Action” means that the fill may not become effective for up to 4 weeks after the fill. That is why the ALLERGAN protocol states that fills should not be performed on patients who will not have access to medical care for at least two weeks after a fill.

2. The patient's stomach capacity is lessened as a result of the restriction caused by the Lap-Band.

3. The patient loses weight because they cannot eat as much food.

4. The residual fat-pad between the inside of the Lap-Band and the outside of the patient's stomach reduces in size because of the overall weight loss in the patient.

5. The reduction of the residual fat-pad causes the Lap-Band to become loose again.

6. At that point, the patient needs another fill, because the Lap-Band is loose, and the patient has a loss of restriction, which allows the patient to eat larger amounts of food.

7. The patient receives another fill and the process starts all over again.

Most Lap-Band patients receive several fills to adjust the Lap-Band as their weight loss progresses, and there is less and less residual fat-pad between the inside of the Lap-Band and the exterior of the stomach wall. Once a patient has lost all of their residual fat-pad, fills become less common. As the Lap-Band patient progresses in their weight loss, the effect of very tiny fills (Less than .2ccs) becomes greater and greater.

It is not uncommon for a late-stage Lap-Band patient to experience a significant difference in restriction with as little as .05cc of fill.

Came across this and thought it might be helpful down the road...

"The father of bariatric surgery in this country, Dr. Edward Mason, performed a series
of experiments on his patients’ and their pouches. He found that all pouches grew in
size during the first 2 years after surgery. Most pouches wound up with a capacity of
about 6 ounces (180 mL). Some pouches were as big as 9-10 ounces. Interestingly,
the size of each patients pouch did not correlate with weight loss (up to about 12
ounces or 1.5 cups). It turns out that how a pouch is used is more important than how
small it is when considering weight maintenance.

OBSERVATIONS FROM SUCCESSFUL PATIENTS AND BARIATRIC SURGEONS
• Getting a sense of ‘fullness’ with each meal is essential to success. Avoid grazing.
• Regular meals larger than 12 ounces (1.5 cups) will result in eventual weight gain.
• Lightly stretching the pouch sends a signal to your brain that you do not need any
more food.
• Maintaining that sense of fullness requires keeping the pouch stretched for awhile.
• Fasting for more than 8 hours will lead to a profound sense of hunger.
• ‘Soft foods’ empty from the pouch quickly. ‘Heavy’ foods empty more slowly.
• Meat and slightly cooked or raw vegetables are good for you and empty very slowly
from the pouch.
• Patients who exercise regularly lose more weight and maintain that weight loss
longer.
• Bariatric surgery programs that provide long-term support and follow-up, and patients
that participate in follow-up care and support groups have the best and most durable
results.

YOUR POUCH RULES(!)
1. Meals must be timed about 5 hours apart or you will become too hungry.
2. You should eat your entire meal in 10-15 minutes.
This is contrary to what we told you immediately after your operation. While your
pouch was healing, we emphasized tiny bites, thorough chewing, and long meal
times (30-45 minutes). Now that your pouch is mature and your appetite has
returned, eating quickly will help you to restrict your intake effectively. Eating
small bites very slowly allows your pouch to slowly empty out one side as you fill
the other. The end result is a much larger meal and higher calorie consumption.
3. No liquids for 1.5-2 hours after each meal.
Same principle as above. Fluids wash your meal out of your pouch. Delaying
fluid consumption for this amount of time after filling your pouch allows your
pouch to remain full for a long period of time. This prevents your appetite from
returning prematurely.
4. After 2 hours, begin slowly sipping fluids and gradually increase the rate of fluid
intake until shortly before your next meal.
Your fluid requirements are the same as they have always been. You still need a
minimum of 64 ounces (8 cups) of fluid a day (more depending on factors such as
exercise, activity, temperature...) This fluid goal requires a special strategy to
achieve and still comply with rule #3 above.
5. Water loading can help you buy time and ward off your appetite between meals.
Drinking as much water as possible, as fast as possible will produce a strong
sense of fullness. This should last for about 20 minutes.
• With practice, the above rules and practices should become second nature.
• Avoid absolutes. Special occasions or momentary weaknesses happen to us all. Don’t
beat yourself up, just get back to your good habits and follow the rules of the pouch.
Your decision to have a gastric bypass is a significant and important one. You have
declared to your family, friends, physicians, nurses, and yourself that your health matters
to you. Success requires a significant commitment on your part. It also requires a lot of
help and support from those who care about you, including your bariatric surgeons!
Learn and follow these rules and you will do well.

The "skinny" on the AP:

Allergan/Inamed has a new band in the US called the AP band.
AP stands for Advanced Platform.

There are a couple of differences in this band and the previous ones:

1. Cuff - the cuff on the AP band is 360 degrees around, as opposed to about 300 degrees on the prior bands (there was no cuff around the buckle on the old ones)
2. Cuff length - the cuff on the AP band is 18mm longer/taller than on the previous bands, so the surface area in contact with the stomach is much greater, hopefully increasing the speed of weight loss and maybe reducing the risk of slips
3. Cuff volume - the AP small holds 10cc, the AP large holds 14cc
Note that we do not believe that AP patients will lose MORE weight, just possibly faster. So those of you with the older models, it would definitely not be to your benefit to think about having your band swapped out! 
·         They are either APS (small, 10cc) or APL (large, 14cc). 
·         They are considered by some to be "the next generation in AGBs". 
·         They are considered less likely to cause blockage or obstruction than other AGP types. 
·         They are considered less likely to slip than other AGP types. 
·         They are considered to be less likely to cause band erosion than other AGP types. 
·         Like the VG band it is "Omniform" technology - i.e. the balloon has ribs or baffles and the band itself is curved. 
·         The AP has more of a 360 inflation around the stomach as opposed to the 10cm or 9.75cm (4cc) bands, which have more like 260 or 280 degrees inflation (the rest being the buckle), and the VG which has more like 280 or 300. It is understood that this was simply an upgrade to the existing band to make it easier and less traumatic to remove.
·         The silicone material is much softer than other AGP types. 
·        They are more concentric (rounded) when inflated than other AGB types. 
·         The balloon is pleated to 'grip' the stomach better. 
·         The balloon goes all the way around the inner surface of the band, rather than missing a piece at the locking mechanism. 
·         The balloon is wider.  
·         They have an easier release mechanism to remove the band if need be. 
·         They have the locking mechanism isolated from the stomach. 
·         AP type bands have been FDA approved for the US, but will not be available until the summer at the earliest. 
·         We understand that there are NO plans at this time to discontinue any of the bands Allergan already makes. They still plan to manufacture and offer the 10cm and the 9.75cm (the 4cc) bands as well as the VG band. 
·         new : AP ( Advanced Platform )
·         APS ( small) 
·         APL ( large )