What are "inflations" or "fills"?
Inflations and fills are the terms used to describe the procedure in which the surgeon injects fluid into the band through the port located near the surface of the skin.
What fluid is injected into the band?
The surgeon injects a saline solution into the band.
How much fluid is injected into the band at each inflation?
During surgery, when the Lapband is first inserted the surgeon will usually inject an initial 2mls of saline solution into the band.
At your first inflation, the surgeon will normally inject a further 1ml to take the total fluid in the band up to 3mls.
Further inflations may be required over time. Patients and surgeons decide together whether an inflation is necessary, depending upon factors such as the amount of food the patient is able to consume, the amount of exercise being done and the resulting weight loss.
How much fluid will the band hold?
The Bioenterics Lapband, which is currently being used in New Zealand, holds a maximum of 5mls of fluid. The Swedish Adjustable Gastric Band (SAGB) used overseas holds a maximum of 9 mls.
Surgeons are reluctant to fill the Lapband over 4mls because initial studies showed that overfilling the band caused problems including band slippage and dislocation.
Does it hurt?
Inflations, or fills, are basically painless. At most, patients report feeling a small pricking sensation similar to that experienced when giving blood.
What can I expect at an Inflation appointment?
You and your consultant will usually discuss your eating, exercise and weight loss since your last inflation and decide whether an inflation is necessary.
If an inflation is necessary the consultant will find the port site beneath the skin and use a fine needle to inject the appropriate amount of saline.
After the inflation has been performed you may be asked to drink some liquid to make sure that you are not going to have any significant problems digesting food post-inflation.
How much does an inflation cost?
The amount charged for an inflation varies between the different surgeons.
Prices currently range from $60-$125.
What can I expect after an inflation?
For a day or two following an inflation, you may find it more difficult to ingest solid foods.
Some surgeons recommend reverting to a liquid or puree diet for that period in order to enable the stomach to adjust to the new stoma size and then slowly reintroducing solid foods.
When introducing solid foods you may find that you no longer tolerate foods you were able to eat prior to the inflation. It will be a process of trial and error to establish your new post-inflation food tolerances.
When will I have my first inflation?
Most people have their first inflation 5-6 weeks after surgery. This gives the port site enough time to heal and ensure that the area is not too tender.
However, some patients have found that they have been feeling hungry and unrestricted and have had their initial inflation prior to five weeks.
When can I expect to have my second inflation?
Further inflations occur as and when required by the individual patient.
The patient monitors their rate of weight loss, level of food intake and hunger to determine whether they might be ready for further inflation.
The surgeons assess the patient’s rate of weight loss, dietary intake and exercise patterns and weigh these factors before deciding, in consultation with the patient, whether a further inflation is necessary.
How do I know when I need another inflation?
It can be very difficult to determine when you need a further inflation.
You will probably start thinking about having another inflation if you:
- have stopped losing weight
- are starting to feel hungry; and
- are able to eat larger portions.
It is advisable to try to defer having another inflation for as long as possible for two reasons.
First, according to information discussed at the Australian Lapband Conference held in 1999, patients with a slower rate of inflation seem to have better results than patients inflated to their maximum inflation level quickly.
Second, there is a very fine line between being optimally inflated and over-filled. If you are overfilled you risk adverse reactions and/or damaging the band.
How many inflations will I need?
The amount of fluid injected at each inflation, the rate of inflation and the total number of inflations varies considerably between individuals.
Most people will have approximately 3-5 inflations over the initial twelve month period.
Is the band ever deflated?
It is fairly common for the band to be deflated. Most commonly, the band is deflated when patients have been over-filled and risk damaging the band.
Patients may also be deflated if they continue to lose weight after reaching their goal, during pregnancy or for certain medical treatments.
How do I know if I am over-inflated?
If you are over-inflated you will experience the following symptoms within 1-2 days of having an inflation:
- difficulty keeping food and liquids down;
- reflux; and
- awareness of swallowing.
Being over-inflated not only means that you have difficulty maintaining a healthy diet but can also result in pouch dilation or band slippage which compromise the effectiveness of the band.
If you experience excessive vomiting or reflux immediately after an inflation it is vital that you make contact your surgeon to discuss the situation.
The surgeon may recommend that you have the band deflated to alleviate the symptoms.
