During your surgery, the gastric band is placed around the top portion of your stomach and an access port is placed under your skin, either in your abdomen or in your upper chest near your shoulder. At this time, your surgeon will not add fluid to your band. This will allow time for you to heal from surgery without dealing with the restrictions or discomfort from a tight band. It also allows the surrounding tissues to become firmer, which will help keep the band in place and prevent future problems.
Although you have not yet had additional fluid added to your band, you will probably still lose weight during the first 4 to 6 weeks after surgery. Particularly during the first week after surgery, you will probably have very little interest in food. Pay special attention to this feeling of satiety, or lack of hunger, as this is the sensation that you and your doctor will be working to duplicate later on with band adjustments.
As the weeks progress, you’ll notice that you start to regain your appetite and your weight loss may stop. You’ll probably also notice that you’re able to eat more than you were expecting. Both of these are normal before your first fill.
At 4 to 6 weeks after surgery, you are ready for your first “fill,” or adjustment. This is simply the process of adding—or in some cases, removing—fluid, typically a saline solution, through your access port. The more fluid is placed into the band through the port, the tighter the band will be around your stomach and the less you’ll be able to eat. The goal is to get enough fluid into the band that you have a sense of satiety between your meals and also so that you’re able to feel full after eating very little.
Getting a fill is part of a clinical consultation. You’ll talk to a member of your medical team, often your surgeon, about your eating habits. They will want to know if you’re having any difficulties swallowing, how long you can go between meals, and how much you’re able to eat before feeling satisfied. This information will help your doctor decide how much fluid, if any, needs to be added or removed through the access port.
The adjustment itself is a simple and mostly pain-free procedure. Your doctor will usually have you lay down and will then feel for the port site with their fingers. They will then mark the spot with a marker pen and swab the area with an antiseptic. A syringe is then used to insert a needle into the port and all of the fluid in the band is removed; this allows your doctor to make sure none of the expected volume is missing for any reason. The fluid will then be put back into the port, along with any additional fluid that has been deemed necessary. After the fluid has been added, the needle is withdrawn and a bandage may be placed over the injection site.
The only time you may feel any pain or discomfort is when the needle is inserted into your skin. This will likely feel similar to getting blood drawn. The fat that is underneath your skin has very few nerves, so you shouldn’t have any additional sensation once the needle has broken the skin.
In some cases, your doctor may do a fill with the aid of an x-ray. If this is done, you’ll be asked to stand in front of an x-ray machine and drink a barium liquid. The x-ray will show the liquid passing into your stomach, and your doctor will add saline into your port until there is only a narrow column of barium passing through the band. Adjustments using this radiological method are rare, as they’re more expensive, time-consuming, and typically unnecessary to achieve adequate fit.
Immediately after an adjustment, you may notice a tightness in the area for the first few days before the band and your stomach resettle. After a few days have passed, you should notice that you can go several hours before feeling hungry. You should also notice that you feel comfortably satisfied after eating a small amount of food. It’s important that you “listen to the band” and stop eating at this point. If you attempt to eat beyond feeling satisfied, you may stretch the stomach pouch created by the band, and you’ll most certainly hamper your weight loss efforts. Effectively creating these feelings of satiety between and after meals with proper adjustments will be the key to your weight loss success, but you’ve also got to acknowledge those feelings.
After your first fill, you will likely have regular follow-up appointments with your doctor about once a month. However, not every appointment will require a band adjustment. While some people never need any further adjustments, most people require five or more adjustments during the first year. The rate of your weight loss and your eating habits will determine your individual fill schedule.