13 January 2021


Section 21: My gastric band adjustment record


Name:  

Date of birth:   

Date of operation: 

Surgeon:  

Band type & capacity:  

 

Adjustment number 

Date 

Fluid found in band if fluid checked 

Fluid added/removed 

Total in band 

Weight 

Practitioner initials 

1 

/     / 

ml 

ml 

ml 

kg 

 

2 

/     / 

ml 

ml 

ml 

kg 

 

3 

/     / 

ml 

ml 

ml 

kg 

 

4 

/     / 

ml 

ml 

ml 

kg 

 

5 

/     / 

ml 

ml 

ml 

kg 

 

6 

/     / 

ml 

ml 

ml 

kg 

 

7 

/     / 

ml 

ml 

ml 

kg 

 

8 

/     / 

ml 

ml 

ml 

kg 

 

9 

/     / 

ml 

ml 

ml 

kg 

 

10 

/     / 

ml 

ml 

ml 

kg 

 

11 

/     / 

ml 

ml 

ml 

kg 

 

12 

/     / 

ml 

ml 

ml 

kg 

 

13 

/     / 

ml 

ml 

ml 

kg 

 

14 

/     / 

ml 

ml 

ml 

kg 

 

15 

/     / 

ml 

ml 

ml 

kg 

 

16 

/     / 

ml 

ml 

ml 

kg 

 

17 

/     / 

ml 

ml 

ml 

kg 

 

18 

/     / 

ml 

ml 

ml 

kg 

 

 

Remember: the number of adjustments required is different for every patient. The average is around 8 in the first year and 2-4 in the second year, with occasional maintenance adjustments after this. However, some patients may need far less than this, and some more. Should you undergo more than 18 adjustments, we can provide you with a card on which they can be recorded. 

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