Ask Dr. Curry

Dr. Curry,
 I posted this question on the forum board, and as per the request of those interested in the topic, I was strongly encouraged to post the question to you to get your perspective.

Hi,
There has been discussion on the board about the impact of fills/unfills as a recurring pattern. I understand the notion as: once we have been unfilled for more than a few days, scar tissue can fill in - so a NEW good level may be much different than in the past. some docs and many patients don't know this, but it's very important.

What might the long term/short term impact of this scar tissue be? Where does the scar tissue form? Might there be a possibility of developing too much scar tissue? How do you not develop scar tissue? How can you know/find out if scar tissue has developed?

This discussion content came from Sandy R and here was her response:

SandyR Portland, OR Pedro Kuri, M.D. Lap Band (03/25/03) Member Since: 05/20/02 [Latest Posts]

Post Date: 7/28/08 12:29 am Yes, this is fairly common. I have experienced it, as well as a number of my own patients and others I  know. I was probably the one who mentionned it, right? That looks like my quote. It probably takes more than a week or so for scar tissue to start to fill in, and it will occur more with people who have lost a lot, need a total unfill, and then the band is quite loose again.  It probably happens rarely in people who have not lost a lot yet and are unfilled for only a couple weeks.   When the band is loose, the new scar tissue forms under and around the loose band. there is nothing that can be done to prevent it, other than learning and following good band habits so we rarely if ever need to be unfilled for long periods. This means getting back quickly for overfills, so we only need a small bit out. if we wait days and get into more and more trouble, we can easily need it all out, and weeks of rest before we ccn start with slow fills again. There is no way to tell for sure that it has developed, other than finding that a new good level is quite a bit less than the old good level. Nothing can or need be done about it. There is not much longterm impact. My mentionning it simply meant that people cannot expect to just jump right back to an old fill level after being unfilled, and that procedding with slow, gradual fills again is very important. and not to expect the new fill level to necessarily be anywhere near the old good level. My own example is this:  I had a small esophagus dilation after goal. I needed a total unfill for 3 months. when i went for the unfill, my fill level was 3.2 and I thought quite good (but obviously a bit too much if my esoph. had dilated), After I started with fils agaun, I could not get one drop past 1.9 cc without starting severe reflux. Dr Kuri and the others I asked for an explanation said that scar tissue must have filled in when my band was unfilled and loose (I has lost like 110# to goal), and all of them had seen it before. sandy R, BSN, MN band educator at goal 4.5 yrs

Please share with us your professional opinion about this topic? any experience with this notion?

Thanks!

I don't think it has anything to do with scar tissue but when you unfill the band I am pretty sure that it changes position a little as the pressure is reduced.  This can cause a change in restriction which can result in a different volume of saline for your sweet spot.

Hello Dr. Curry....

I had my surgery for the lap-band 4 weeks ago today, and my port incision has still not closed up. The other four small ones have healed nicely.  I have had previous problems with incisions healing (because of my type 2 diabetes) when I had my triple heart bypass in 2005.  I had to go to a wound specialist to help me get it healed.  I have gone to my PCP about my port incision and he gave me a prespcription for an antibotic for the redness and minor seeping.  He also had me get an OTC salve (polysporin) to put on the incision and told me not to cover it.  I can see it is getting better, but still hasn't healed to where it is closed yet.  I notice that when I stand up, the incision will gap more than when I'm sitting, because my sagging belly pulls on the incision, causing it to re-open some.  I have been wearing a tight girdle-like underwear to keep my belly from pulling so much on the incision.

My question is that I am due for my first follow up appointment with my surgeon on the 4th of August, and thought that he may give me my first fill on that appt. since I have over 180 plus miles to travel just to get to him.  If my incision is not closed up by then, will he still give me a fill or have me wait until it's healed, and if he does want to give me a fill, how will he do it with an open port incision?

Thanks in advance...
Susie

I was banded 04/16/08, and I initally lost 16 lbs - including the 2 week pre-op diet.  I lost an additional 4 lbs after my first fill, but then stopped.  I had 2 more fills, but felt no restriction.  The short version of this story is, I returned to my surgeon, after a total of 3 fills and no restriction.  He verified that the nurses at the after care facility were not filling my band at all.   He filled it, I went back a week later to make sure the fluid stayed (making sure there was no leak).  In that week, I'd lost 4 lbs.  It's now 2 weeks later, and I've lost nothing.  What makes this more frustrating, is I work out (cardio) 45 mins a day at LEAST 3 times a week.  I've also been keeping my total calories @ 1200-1400 per day.  What else can I do to see some results?

2 weeks after achieving restriction is not enough time.  We frequently see in patients who lost a lot on their preop diet that the first few months after surgery are slow in terms of weight loss.  If you are doing the right things it will start up again.  Make sure you are getting at least 60grams of protein and keeping your carbs well below 50.

Dr. Curry, how and why does stress affect the band? I am two years post op and wonder why in times of increased stress my band seems to be more restrictive. Is this true of most patients?Thank you in advance for your response.

I think it has to do with the motility of your esophagus but nobody knows for sure.  I can tell you that it does exist, you are not crazy!

Hello. I had lap band surgery on June 30 of this year. Immediately after surgery I feld a weird tightening in my chest. This would come and go, every 5 or 10 minutes or so. It felt like I swallowed something and it went down the wrong way. I told my surgeon, we had an x-ray and everything looked fine. After about 4 or 5 days, this feeling went away. Now, a month later, the feeling is back with a vengence. It feels like I swallowed a baseball. Again, the feeling comes in waves. It literally makes me bend over in pain. This seems to have no relation to food. No matter what I eat, I have the feeling. I have yet to have a fill.

Do you have any suggestions or know why this is happening? Am I the only one? Will this feeling go away again?

Possibly these are esophageal spasms.  They may go away with time, but I would see your surgeon for sure just to get checked out.

Hi Dr. Curry,

I have a friend on here who had surgery the same day  I did but after 2 fills for each of us I'm at a 4cc in a 10cc band and I think she may be at 2cc.  Her doctor is saying now that he will only give her .5cc on fills.  She has no restriction, she's gaining weight and becoming very frustrated and losing hope.  I guess my question is, is it correct to give such small fills?  If so any sage words of advice for her?  I'm still shocked that her doctor won't give her bigger fills, maybe my doctor is just extra aggresive in the fill department.  She did talk him into a full cc this time instead of .5 but he ignored her when she requested 2cc.

Correction:  She's had 3 fills, 1 cc each.