little confused

Hi everyone. I went to my first face to face one on one consultation today with female doctor from Our Lady of Lourdes hospital group of 2 surgeons.. she mentioned that they do a 40 f bougie.. on different support group blogs the people talk about getting 32f 34f 42f size depending on the techniques the doctor uses...This team said after doing it this way now over 2 years they have same results rate at doctors do a 32f. Do you have any idea what they taking about? Which did you get?

The bougie is the guide the surgeon slides down through your esophagus into your stomach that he/she buts the staple gun against to create your sleeve.

Since the sleeve is not a standardized procedure, everyone's doctor does it slightly differently.  I know my surgeon doesn't use the same size bougie for each patient--I had a 32f, and my husband had a 36f (both of us used the same surgeon). 

There are a few members here who have been very successful with different sized bougies...what matters more is how you choose to work the tool your doctor will give you after they're done making it for you.  Someone with a 32f sleeve can fail or succeed just as easily as someone with a 40f if they aren't mindful and sticking to a good food and exercise plan post-op.

Thanks for your reply. I guess I'm just trying to see what's best ?

different sizes all have advantages and disadvantages , small sizes tend to have more complications early , more leaks , harder to eat and drink at first , but the take longer to stretch and some say they stretch less

bigger sizes you have less problems eating and drinking but sometimes you can eat to much

my surgeon uses a 34f and I have had good luck with it

size 40 and larger are used more with the ds than the vsg

more important than the bougie size is technique, a great plan and using your tool correctly 

also a good support group helps a lot

Thank you.

Hi There! My surgeon will be using a 40f for my sleeve. The difference between a 32 and a 40 is only about .10 inches. Not too much. My Dr has used different sizes and has found that the 40 nets good results with lower complcation rates.

Thanks. That's what my surgeon said ...I'm a little nervous not knowing exactly what is the best for me though ..smaller 32f or what my doctor does.. i do have another consultation also in February 3 with another doctor just to compare

Mine is 40f. I've lost 35lbs this first month. Don't let anyone tell you that you won't lose weight efficiently with a larger size!

WTG rengirl! I get mine on the 5th, and am going for good results like yours. I know it's all about how you work your sleeve, so kudos to you !!!

I'll tell you what I know about it after learning about this for the last 5 years........Take it or leave it..... It's the truth as I know it......

First you have to understand that the VSG is NOT a standardized procedure and in the recent few years more and more surgeons are doing this procedure as more and more insurance companies have been covering it.

Surgeon experience can range from just several to several thousand VSG's performed. End results can range from 40-80% EWL averages for individual surgeons with a national average of 50-60% EWL.

My surgeon started doing the VSG as a stand alone WLS near 15 years ago and did bougies in the 40's at first and as his procedure evolved the size got smaller. With the smaller bougie size WL was better and the most important stat is the he had a significant reduction of regain long term after WL. 

All that said, eventual capacity seems to be the key....... 

Some will say the difference in sizes is miniscule, or it's only a tenth of an inch or sometimes the comparison photo of the pens appears. So, if it's so small (miniscule) of a difference why can some post-ops eat 2-3oz. and some can eat upwards of 16oz. ???? That's not a miniscule difference.......

The larger the sleeve, more stretchy tissue is retained. A proper 32f sleeve starts out at around 2oz. capacity and doubles to about a 4oz. capacity. It is common to read about people with bougies in the 38-40 range to have eventual capacity in the 8-12oz. range.

 

Here is the kicker..... smaller sleeves are much harder to make and one should never ask a surgeon to go smaller than his/her experience. Smaller sleeves can have a higher complication rate for the less experienced. Smaller sleeves need great attention to food flow to keep reflux to a minimum. A common mistake in making smaller sleeves is to get it to tight in the middle like an hourglass shape. This will cause food and acids to go up and push on the esophagi sphincter and flapper valve.

So the trend is to go larger with the sleeve because it is just easier to make and more forgiving early out with generally less issues. But many programs are going for 50-60% EWL as a successful goal.

 

Keep in mind..... long term.... 100cals a day over your caloric balance point is a 10lbs. gain in a year. Most proteins are about 50cals an ounce.

WLS is really not about WL specifically..... it's about keeping the weight off that you lost........

Higher BMI patients can typically use the help of a tighter sleeve with more restriction.

Are you doomed if you have a larger sleeve..... NO...... but you may have to try harder and it will be easier to stretch your sleeve if you abuse it by constantly over eating.

This chart is just an example of how I see it. What it really means is that if your short in one area your going to have to make it up in another.....

frisco