Band Adjustments

Band adjustment is the key component for weight loss success after undergoing placement of the gastric band.  This underscores the importance of maintaining close follow up with your surgeon.  The adjustments are generally done in our out patient clinics.  The process takes just a few minutes and the overwhelming majority of patients report absolutely no discomfort during the procedure.

The decision to perform a band adjustment is made by the surgeon and the patient.  If the surgeon feels that it is not in the patient's best interest to have an adjustment then the surgeon's decision will stand.  Believe it or not, a common cause for weight regain after band surgery is the band being too tight.  Patients are unable to tolerate appropriate food items and inappropriate, soft, calorie dense substitutions are made with resulting high calorie intake and weight regain.

In general, the decision to perform a band adjustment is based on:

• Weight loss
• Volume of food that a patient can eat at any one meal
• State of appetite
• Degree of food obsession (excessive thinking about next meal)

The first band adjustment is generally done at or after 6 weeks to allow for the position of the band to be firmly in place.  Additional adjustments are performed at the discretion of your surgeon on a 2 to 8 week interval.  Most patients will require on average 6 adjustments during their first year although a small percentage of patients may require as many as 10 adjustments until the "tightness" of the band has been optimized.  After the band has been appropriately adjusted most patients will require one or two adjustments during their second year and possibly one or two adjustments thereafter on an annual basis.

If you have an appointment and are reasonably sure that an adjustment will need to be performed there is generally very little that you need to do to prepare.  We recommend that you do not eat anything for 4 hours prior to the adjustment.  You can drink liquids until one hour prior to your appointment.

Adjustments are generally performed in the office.  The area is sterilized with either alcohol or iodine. The port is accessed with a specialized needle and sterile saline is injected into the band.  The adjustment is generally not painful and takes only a minute or two.  If the port cannot be accessed in the office because of difficulty feeling the port the adjustment may have to be done under fluoroscopy (X-ray) - this is uncommon in patients with a BMI less than 50.  This is done by the surgeon in the radiology suite.  It may require that a scheduled appointment depending on the day and time.

After the adjustment you will be asked to follow a "post band fill diet".  This is simply the post operative diet in a rapid form.  Weeks one through four (click to see post operative diet) would be condensed down to single day steps. 

For example:

Day of adjustment: Week 1 diet
1st day after adjustment: Week 2 diet
2nd day after adjustment: Week 3 diet
3rd day after adjustment: Regular diet

If at any point you find that you are having difficulty during your progression then step back to the day's previous diet.  Over a period of a few days you will likely be able to make your way back to a regular diet.  If you continue to have difficulty please contact your surgeon.  If at any point you are unable to tolerate liquids you should contact your surgeon immediately.