band adjustment -- office vs. fluoroscopic

I am posting this because I get asked about this alot. RE: What is the difference between a fluoroscopic adjustment and an office based adjustment.  I perform almost all adjustments in the office. The port is located by feeling it. In the rare instance (<2%) that the port can't be felt or there is some uncertainty regarding the position, then I would do the adjustment in the x-ray department at the hospital under fluoroscopy which is a "live video" x-ray. I do this solely to help identify if the port has flipped and also to help guide the needle into the port if I couldn't feel the port. I believe most surgeons are performing lap-band adjustments in the office. The whole process usually takes a few minutes. I find it is a hassle for the patient to have to come back and be scheduled for the adjustment under x-ray. It should be understood, that it is possible to overtighten the band. For that reason, I continually tell patients that it is an emergency to loosen the band if a liquid diet cannot be tolerated. Some surgeons may have a patient drink barium as the Lap-Band adjustment is done and do a fluoroscopic x-ray of the barium being swallowing and going through the band. This is done with the belief that estimating how quick or how slow the barium moves through the band will tell if the band is tight enough or too tight. I do not believe that this information provides any clue on whether solid food will get stuck or whether the band will provide enough restriction to help with weight loss and hunger control.  On occasion, I will have a patient get an upper GI, also known as a barium swallow, where the radiologis****ches the barium move through the esophagus, band, and into the lower stomach. When I order this test, I am evaluating the band for a slip, which is also known as a gastric prolapse. No adjustment is done to the band at this time.  I hope this clears up any confusion on the use of x-ray in Lap-Band adjustments.  David R. Geller, MD Medical Director Norton Suburban Hospital Bariatric Surgery Program Bariatric Surgeons of Kentuckiana 4001 Dutchmans Lane, Suite 1E Louisville, Kentucky 40207 (502) 893-7151, fax (502) 893-7020 [email protected]

Thanks Dr. Geller for the info.