The secret to weight loss following adjustable gastric band surgery lies in no small part with the skill of the surgeon in placing the band correctly in the first place and then with his skill in adjusting the fill of the band in the weeks following surgery.
In many cases the band will not be filled at all during adjustable gastric band surgery to allow for normal post-operative swelling of the stomach, or will be given only a minimal fill, depending upon the preference of the individual surgeon. This means that, initially, there is relatively little restriction on the passage of food between the two sections of the stomach and some patients are surprised to find that they can eat fairly large portions.
The role of the surgeon post-operatively is to gradually inflate the inner lining of the band until the point is reached at which the restriction on food intake creates the maximum weight loss, while still allowing enough food to be eaten to meet the body’s need for water and nutrition.
In many cases the starting point is to assess the placement of the band (as well as the associated access port and connecting tube) to determine the initial level of restriction and to see whether or not there are potential concerns such as an enlarged pouch, a prolapse of the stomach or dilation of the esophagus.
This investigation is normally carried out using a fluoroscope. This is a relatively simple form of x-ray investigation in which the patient is given a small quantity of liquid to drink and the radiologist then records a series of x-ray pictures as the liquid passes down the esophagus into the newly created small pouch and then on through the restriction created by the band into the main section of the stomach.
For a small number of patients the initial restriction provided during adjustable gastric band surgery will be sufficient and there will be no need for adjustment. However, in the majority of cases, a series of adjustment, or “fills”, will be made with the number of adjustments varying between patients.
In most cases the surgeon will allow up to six or eight weeks for the stomach to heal before starting to fill the band and then will allow between two and four weeks between fills until the desired restriction is achieved.
One major difference between surgeons can be seen in the speed with which the band is filled after surgery, both in terms of the degree of fill and the time between fills, with some surgeons adopting a far more aggressive stance than others.
As a result it is vital that you discuss post-operative care plans and diet with your surgeon and other members of his team before surgery, as there can be considerable variation in treatment between weight loss teams. Choosing a team with a post-operative care plan to suit your needs will not only make a considerable difference to your experience of the whole process, but will also be reflected in the weight loss seen in the weeks and months following adjustable gastric band surgery.