Sleeve size vs RNY pouch size?

I had RNY almost 4 years ago (and the sleeve was not an option at the time), but I work with clients who are considering WLS so I need some info.  It was my understanding that the size of the sleeve is comparable to the size of a mature RNY pouch -- just very differently shaped, retains the pyloric valve but loses the remnant stomach, etc. -- but several people have responded to posts on the RNY board about choosing RNY versus VSG by saying that they chose RNY because they wanted more restriction than they would get with the VSG. 

So... now I'm confused... and I have a client whose pre-op information paperwork seems to indicate that my understanding about the two surgeries having comparable "new stomach" sizes is correct, but people who considered the VSG and chose RNY are telling me something else.  Can someone tell me what the real deal is?

Lora

 I won't even have a pouch. My surgeon says mine will be about the size of a bic pen. lol Just a narrow sleeve straight on down.  I cannot imagine more restrictive then that. I've been warned that swallowing water will be difficult at first.

All i can say is that a little over a year postop and i still have great restriction.  If I'm eating dense protein for a meal (boneless chicken breast for example)..I can eat 2.5oz and nothing else.  Sometimes for lunch I'll have 1/2 cup cottage cheese and 1-2oz of cubed cheese..that's all I can fit.  They use different size bougies for the sleeve (the instrument that's inserted into the stomach that they use as a guide to cut around).  Mine is a size 32 (the smallest my surgeon does, and I think the smallest most surgeons will do).  But then again, those w/a 32 bougie used on them may still be able to fit in more food than I can, depending on the length of their stomach as well.  Everyones stomach is different.

 so Dawnie if I understand you the higher number bougie makes the smaller stomache.  Most people on the site usually say they have like a 22 or 24.
Cheryl  

Nope..the smaller the bougie..the smaller the stomach.  I've never seen anyone on this forum with a 22 or 24.  Correct me if I'm wrong..but a 32 (what i have) is the most common..and smallest I've seen most of us have.

 I am sorry.  I remember now that it is in the 30's and 32 would be the smallest.  thx
 

I really wish i could explain, all i know is that both are retrictive procedures but , the sleeve is not reversible and RNY is because of the re routing of the small intestine and that RNY is malsorbing and the sleeve isnt. I believe yes the stomach pouches are the same in size but alot choose RNY because of the malabsorbtion. Your best bet would be to ask your doctor about this and see what he says.

I'm almost 2 years out, and when it I compare my restriction to my RNY friends here, I can without a doubt state that I have more restriction with dense protein foods than they do. For slider foods, I think it's about the same from what we've talked about over the years. So, I think it still defaults to what we choose to put in our mouths.

I think if you do a search on bougie sizes there is a picture showing 5 bic pens, the smallest being the stanrdard white with blue cap ink pen, then to a rollerball type, a sharpie type, a highlighter then the largest being a permanent marker.  Those are the sizes of the stomach after surgery.  Of course as one of the previous poster mentioned people have different lengths of stomach so my stomach may hold a tiny bit more or less than another persons depending on the length of the stomach.  The other interesting thing is that the section of the stomach containing the hunger hormone ghrelin (not sure of the spelling) is removed during the gastrectomy resulting in little or no hunger.  My personal decision involoved the malabsorbtion.  I have liver disease and already have malabsorbtion so I don't need to have additional issues due to vitamin defiencies that would be detrimental to my liver health.  I also wanted to be able to eat as normally as possible without worrying about some of the food items I was told I would probably not be able to eat with RNY.  (grains, breads etc)

I don't know about the size of the RNY pouch, but I can tell you that the VSG stomach size depends on the bougie size and the surgery technique used by the surgeon.  In other words, it varies quite a lot.  I have seen people able to eat three times what I can eat after surgery.  I am talking about healed and fully matured stomachs.  This surgery is just not standardized yet.  I am almost two years out, and I can eat about 3-4 oz. of dense meat or 2 oz. of dense meant and 2 oz. of veggies.  I can eat about 1.25 cups of chili and an unlimited number of junk.  According to my doctor, my stomach should not stretch past this point.  I hope this helps.