Adjustment Methods

There are various accepted techniques and protocols for adjusting the gastric band. They include:

• Image Guided Adjustments:*This is the type performed at Banding Centers of America*

• Fluoroscopy (a type of X-ray) is used to guide the adjustment process visually. The fluoroscopy is painless and the amount of radiation exposure to the patient is minimal (not dangerous). It is especially helpful to place the access needle into the adjustment port in difficult circumstances.

  The adjustment is "guided" by having you swallow a water soluble contrast agent (Barium), which can be seen. The band is then adjusted while you and the doctor are looking at the X-ray viewer until the desired degree of restriction is obtained. The degree of appropriate restriction is determined by both the visual information and the verbal feedback from you.

  Patients are awake during the procedure and enjoy seeing the process. The combination of "how it looks" and "how it feels" allows the adjustment to be precise in a single session. This method also receives a high patient satisfaction rate due to the reduced need for follow-up adjustment visits, reducing the amount of disruption into your daily life. This method also reduces the incidence of over tightening of the band. (Another benefit of image guided adjustments cited by many surgeons is the ability to identify abnormalities related to the gastric band. )

• Regular Scheduled adjustments with predetermined volumes of saline:

• A "one size fits all" approach. This involves a strict regimen of fluid addition, treating each patient according to a pre-determined protocol of fluid addition along with scheduled frequent follow up visits. Adjustment proceeds along the protocol pathway until an effect is seen. Adjustment frequency can range anywhere from every 3 weeks to several months. Adjustment timings and saline volumes in this mode are strictly based on the premise that the patient follows the nutritional and post-operative guidelines.

• "Open Door" protocol where patients are seen whenever they feel the need

• Under most circumstances, the adjustments in this scenario are performed based on a predetermined volume protocol as in the first example and continue until an effect is noticed. The volumes instilled at each visit, and the followup visit schedule vary based on individual experience and their feedback.