We use the Allergan Lap-Band and use only the two Advanced Platform models (AP standard and AP Large). There are three other bands that Allergan makes, the VG (Vanguard) the 10 and the 9.75 cm – which we stopped using in June of 2006, but are still used in Mexico. We think the Advanced Platform is a better band. The older bands were a high pressure type and held about 4 cc, but most were comfortable at 1-1.5 cc. The Vanguard held 14 cc, but most found their sweet spot at 7 cc.

The AP Standard band holds 10 cc but we find that most people’s sweet spot is at 5.5 cc. The AP Large holds 14 cc but most people find their sweet spot at 7.5 cc. If we have to go over that amount we are very cautious because the band is a semi-permeable membrane the amount can vary by 1 cc. So it is common someone will come in with 6 cc in their band, feeling it is too tight, when all we had put in, and measured, was 5.5 cc.

Starting Out
When we place the lapband initially we have a chance to see what looks ideal at the time of surgery, and for most people that is 3 cc. Some people feel tight with that amount, and we have to remove some fluid quickly — they will notice chest pain, difficulty swallowing, shallow breathing, and just be uncomfortable. As soon as we take out fluid they feel better.

First Fill
Our first fill is after a person is on a solid food diet – NOT BEFORE!!! Solid food is how the band is designed to work. If you are hungry sooner – don’t advance your diet- increase your protein shakes (we usually like people to have three Visalus shakes a day- it contains 12 grams of protein, and that keeps them from going into a negative balance).

Follow up Fills
The first fill is usually 1.5-2 cc depending on if we get any resistance in our syringe. At first if we get some bounce back and don’t let it equalize people come back to the office quickly for an unfill (usually after a miserable day or night or two). How often a person needs them varies- but we know this: you cannot tell until at least five days go by. How can you tell– by eating a measured amount of small food (1/2 cup of meat, fish, or poultry and 3/4 cup of vegetables) and seeing when you get hungry after two hours (first two hours don’t count).

Restriction
We never use this word in our practice – because that is NOT how the band works. People who use this word didn’t get it from us, but mis-informed individuals. If you feel something with your band then you are either eating too fast, or have your band way too tight. We want the band to suppress appetite – and it takes a while to get this, but work on this thought from the beginning.

Typical Course
We find that most people need 4-6 adjustments in their first year, and 2 in their second, and then they are usually pretty set. There are occasional needs for a bit more, or tweaking- but often that is more needing a refresher course in how the band works.

Once we reach 4 cc in the AP Standard or 5 cc in the AP Large it has been our experience that we can only fill 0.5 cc at a time. More than that and we are most likely to see you back in the office for an unfill.

How it Works
The band works by amplifying the signal between your stomach and your brain. You should feel nothing. If you feel something you are doing the band wrong.  Your job is to be the adult in the band relationship — measure food, eat slowly, eat healthy. The lapband will keep you from getting hungry after two hours.