Follow-up of the obese patient, especially one who has undergone a LAP-BAND procedure, is an essential part of the treatment.

One of the surgical advantages of the LAP-BAND System is that the stoma size can be adjusted post-operatively to individualize patient care without additional surgery. The tissue trauma and fold-flaw failures caused by triangulating designs are eliminated altogether with the LAP-BAND System's unique pre-shaped circular inflation membrane.

Therefore the percutaneous adjustment of the system is a possibility which has to be exploited at its best in order to maximize the results of surgery and find a personalized solution for every patient.

Our method is as follows:

1. Gastrostenometer

At surgery we routinely utilize the Gastrostenometer (electronic sensor) for stoma size calibration. Properly using this device two types of information can be obtained: a) number of cc. which should be inflated in order to obtain the ideal stoma size. b) the right or wrong position of the band.

2. When and How Much to Inflate

During the early post-operative days stoma oedema may temporarily decrease the stoma size. This is the reason why most surgeons prefer to leave the system empty at surgery.

Instead our policy is to inject half the amount of saline needed to reach the ideal calibration and to immediately check by means of the calibration tube, if passage is guaranteed.

Afterwards we adjust the system, without a predetermined schedule, only if the patient stops losing weight (absence of dietary problems) or in case of problems (vomiting, obstruction, oesophageal enlargement, etc.)

In case inflation is needed we never inject more than 1.5 cc. at a time. In fact we prefer to have the patient adapt slowly to the new restrictive situation. If the injected amount turns out not to be sufficient a further adjustment is done 3-4 weeks later.

In case of problems (vomiting, obstruction, oesophageal enlargement, etc.) we completely deflate the system. In the following weeks we gradually inflate the system again with no more than 1.5 cc. at a time.

3. X-Rays

We strongly believe that before and after any adjustment a barium swallow and a direct fluroscopy control of the oesophageal situation (motility, size) and the passage of the contrast medium through the stoma have to be carried out.

We would like to stress that adjusting with no X-rays, relying for instance only on the capacity of the patient to swallow some water, is totally misleading and can cause even serious complications.

4. AIM
A step by step adjustment, performed when and if the patient needs it, aims at:
a) a good weight loss curve, b) prevents vomiting c) allows intake of solid foods.

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