- Name: Ginah Clark
- Username: kulita
- Member Since: 3/10/2006
- BMI: 33.7
- Post Op
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VSG BOUGIE SIZES on May 2, 2013 5:12 pm
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A BOUGIE (boo-ghee)...
IS NOT THE SIZE OF YOUR NEW STOMACH!!
The word bougie means "candle" in French. "F or FR/Fr" following a bougie size=French
Its just a guide that the surgeon uses to butt the stapler up against, when forming your VSG. The closer s/he gets to the guide the 'tighter' /truer to guide the sleeve is. During surgery the bougie is inserted into your mouth down your throat, towards the end of yer stomach where it meets the pylorus via an esophageal dilator. After the new stomach is formed, the bougie/guide is removed out of your mouth, possibly why some VSGrs complain of a sore throat post op.
Some surgeons will use an endoscope or other "guide" to size ones new stomach. I read an OH post of a VSGr who's surgeon explained an endoscope is the same size as a 32F bougie...Im not sure.
Bougie size determination is between YOU and YOUR surgeon. Discuss size, rationale for size chosen, type bougie and technique used when sizing your new stomach........ PRE-OP!!
Some surgeons may "oversew" the staple line giving one a 'tighter' than bougie sized sleeve.
In order for an "oversewn" staple line to affect stomach size it MUST be running or continuous oversewn suture line across majority of staple line not intermittent oversewn nor merely at intersected "junctures" where the surgeon has reloaded the staple gun as majority of "oversewn" techniques (to prevent leaks) are done today. Make sure your surgeon explains what his/her "oversewn" technique is. Do not assume because a surgeon "oversews" you have a tighter than bougie sized sleeve.
A bougie is 1/3 mm PER french. i.e to calculate ~ inches 40F bougie 1/3 x 40 = 13.33mm convert to inches = ~.52 inches or ~1/2 inch in diameter.
Below are diameters of bougie/ "guides" in inches
32F = .40"
34F = .425"
36F = .45"
38F = .476"
40F = .5"
46F = .576"
60F = .75"
This VSG surgery video shows a 'red' 34F bougie, one technique in sizing stomach, exised stomach, testing for leaks etc
Red bougies are older mercury filled ones. FDA is tryin to ban em because of disposal issues (mercury).
More surgeons will use SINGLE USE disposable sized bougies
In this surgical video Dr. Alvarez shows a disposable 32F bougie and use/technique
32F bougie inserted in an esophageal dilator
Nursgirl VSG Forum member's bougie pix from hospital she works 1st: 36F, 2nd: 38F on left, 32F on right
General/ crude comparison chart created by MACK a VSG Forum member
Standard sized bougies in the US and Mexico are 32F. 32F is the smallest guide a bariatric surgeon in the US may safely use in forming your sleeve. Your surgeon may prefer any size bougie from 32-50F, based on YOU, your height, weight, or perhaps the need for a malabsorptive procedure in the future, inc. 1st step of 2 part DS. Discuss what to expect, rationale for size chosen with your surgeon if this is a concern.
LapSF/Dr. Criangle on their routine use of 32F bougies in VSG "Optimal weight loss may require the smallest possible pouch, which may yield the highest leak rate" .
Some surgeons will welcome discussion, your input on bougie sizes. For instance, my surgeon recommended a 32F bougie for me. After reading a published journal on the higher incidence of VSG surgically induced GERD (acid reflux/heartburn) in use of 28-32F bougies, I instead, requested a 34F bougie. My surgeon obliged me. Post op I never needed or took a perscribed or OTC PPI. Coincidence? more than likely!
In ~2000 use of 50-60F bougies were standard for VSG when it became a stand alone WLS, as they were the standard sizes of DS bougies, which VSG was modeled after. As the years went by, bariatric surgeons thought..smaller bougie, better restriction, less regain. So in ~2005 an adopted 32F bougie became the VSG standard. Rarely, if ever are 28-30F or 50F and over bougies used in the US for VSG as stand alone anymore. Many many VSGrs do EXTREMELY well with 40F-48F bougies as the guide to sizing their new stomach, losing all the weight they need to.
An ~2012/13 study (a very large poll) on Bougie Sizes in VSG seems to indicate at 3 years post VSG. a LESS than 40F bougie and GREATER than 40F bougie show no difference whatsoever in EWL (eventual weight loss) 2012/13 Bougie Size Comparisons
An ~2009 study (a large poll) on Bougie Sizes in VSG seems to indicate at 5 years post VSG ... 32F and 44F bougies show exactly the same EWL (eventual weight loss) 2009 Bougie Size Comparison
An ~ 2008 study (small poll 135 pts) on Bougie Sizes in VSG seems to indicate at 6 mos and 12 mos post VSG .... 40F and 60F bougies with no significant difference in EWL (eventual weight loss) 2008 Bougie Size Comparison
VOLUME/GASTRIC CAPACITY in VSG:
PRE VSG: Average stomach holds 32-48 oz or 4 to 6 cups per meal
POST VSG (~6-8 months out FOR LIFE) ..new stomach holds 8-12 ozs or 1 to 1.5 cups per meal
(depending on weight/density of foods you eat! can be much less or much more)
The length of an adult stomach is 10-12 inches. DNA affects the length of our stomachs, as well as variations in shape. Tall people, for instance are known to have longer stomachs..so makes sense they have a bit more capacity, short people have shorter stomachs therefore less capacity.... so volume/capacity can be influenced by the length and physical anatomical variations of an individual's stomach.
Dr. Alvarez explains in this You Tube video about length of an individual's VSG stomach and how it relates
to volume. http://www.youtube.com/watch?v=-5E7G0Avz4w&feature=share
This limited 2009 study is interesting in looking at gastric capacity in VSG,
just 3 days post op (120 ml=~1/2 cup) compared to 2 years post VSG (250 ml=~1 cup)
At the end (8:28 mark) of this LapSF VSG surgical video shows 1 DAY old (pod) sleeve Xray and a sleeve Xray at 4 years out. It is not clear to me if same pt. or solely to impress the new "normal" sleeve size. Note the "new normal" 32F tightly formed sleeve has dilated/stretched naturally to perhaps triple in size...The video also shows one technique of sizing the sleeve, as well as reinforcement of the staple line (to prevent leaks) http://www.youtube.com/watch?v=rRBKdTjY2Rg
This VSG video shows the speed with which LIQUIDS/FLUIDS empty from the sleeve. In normal stomachs fluid empty rate is 5 minutes or less due to space creating a reservoir for large volumes of fluids. In VSG stomachs: fluid empty rate looks MUCH faster than that... youdecide! http://www.youtube.com/watch?v=K0GWL1Wtx30
The COTTAGE CHEESE TEST /CCT (link following) may be helpful to VSGrs that are curious about their new stomachs capacity. It was developed for RNY but an effective tool in VSG as well! I'd suggest waiting until you are on a regular diet before checking. When doing this test PLEASE eat to sensation of satiety - no longer hungry, and absolutely not full.
A simpler method, following the basic guidelines and time frame in the link provided... is to place 1 level cup (8oz) of small curd cottage cheese in a bowl and eat from that. Using a measured tablespoon to eat any remaining cottage cheese from the original container. Add or subtract any cottage cheese eaten or not finished using the measured tablespoon. 2 TBS=1oz. Total...the amount consumed = your sleeve's capacity.
STRETCHING in VSG:
YOU CANNOT STRETCH/DILATE out your sleeve to anything remotely close to its original size.
From LapSF/Dr. Criangle: The removed section of the stomach is actually the portion that stretches the most. The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food.
The fundus (inc. majority of stomachs 'body' up to pyloric canal) of the stomach is ALL but removed with VSG.
The fundus is the upper most part of the stomach's greater curvature. The fundus is:
1) the stomach's stretchy/expandable tissue, capable of expanding 2-3xs its resting 'unfilled' size
2) the pre-op 'mass quantities' of food, waiting to be digested, storage section
3) where 70% of the body's grehlin a "hunger hormone" is produced.
Stretching, due to overeating is most common in RNY because more of the stretchy fundus part of the stomach is retained to make the 'pouch', and is usually NOT covered by insurance to correct. Re-sleeving or a need for a malabsorptive surgery post VSG may or may NOT be covered by your insurance plan.
Anecdotally, Ive read from select OH VSG members, or according to a/their particular surgeon..overeating will cause your sleeve to stretch out. Ive read/found no scientific data, published or otherwise, to date that says this is a TRUE statement.
Since food stays in our stomach less than ~ 3 hours after a meal..common sense tells me food doesn't stay in our stomachs long enough to create 'stretching'. Food once ingested, immediately begins to be churned into a liquidy sludge called chyme through peristalsis in the stomach. This liquidy sludge must be small enough to pass through our very small pyloric valve and into the small intestine for further digestion /breakdown and absorption of 'micronutritents' ...so there cannot be enough pressure for long sustained periods of time in our stomachs to cause it to stretch.
Post op VSG ... depending upon the amount of swelling/inflammation you have..even a little 'thick/er' dense liquids or pureed foods/mushies may or may not feel restrictive, as you pass through the progression of texture dietary phases ( to promote healing) and onto your regular diet ~2mos post op. ... swelling/inflammation has naturally reduced. Density of meals becomes a key player in restriction. By 1 year out you'll find you can eat more than you could at 2 days post op, at 2 weeks post op, 2 months post op, and 6 months post op. Your sleeve has naturally and fully matured.
Depending on the food..you can eat more or less than the 8-12 oz capacity of a fully matured sleeve.......at any particular meal.
Toleration of a food, does NOT make it a good choice!
"just because I CAN...doesn't mean I DO"
The bougie size controversy/wars are ridiculous imo.. 'get a smaller one, you can stretch it out, you're not going to have any restriction, that bigger one is all wrong, you'll re-gain easily years out, my surgeon made mine smaller and I got to goal in 6 months'
...all nonsense DO NOT PAY EM NO MIND!! This is YOUR story! YOUR journey!
ALWAYS REMEMBER THIS TRUTH:
YOUR WEIGHT HAS NOTHING TO DO WITH THE SIZE OF YOUR STOMACH, altered or not!
Most important is the quantity and quality of the food choices you ingest post-op
My date for the sleeve is April 29 on April 23, 2013 6:48 am
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I can't believe in less than a week I will be on my way to a healthier me.
It's 2013! on January 31, 2013 12:41 pm
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Wow so much has happened.
I did not get the surgery as Tricare changed their plan again 1 week before I was supposed to go in. I now weigh 247lb and have High blood pressure too. I have moved away from Illinois and now I am in California. I spoke to a few Dr.'s about my knowledge on the surgery and which one I would like to do. I am going for the sleeve through Navy Hospital Balboa.
What I find wonderful is that they give me a check off list of things that I need to do and the groups here are wonderfully interactive with each other. I feel very supported and soon I will be on my way to a better, healhtier me!
Yay! This is my very first blog ever made. Hmm. Let's see I have been on Oh for awhile now but I am usually a lurker. I just read posts and every once in awhile I will make a post if I feel it will help, but usually I just read them. I just tried my best to spruce up my profile so I hope it looks nice.
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Jan 7, 2008
1st post of the New Year. Ok, I spoke with Susan who works with Dr. Alvarez. I can get the sleeve for 10k and I was ok with that. I am having problems getting financed so I probably will have to get it with my student loans. Dr. seems really nice and I have heard nothing but good things. Mexico seems so far away though. I did more research and found Dr. Pleatman. He will do it for 1k more, BUT it is not all inclusive, meaning I would have to pay for my hotel and tix to go there. Since he is closer I can, er, uh, hubby can just drive there and we can stay at a hotel there so I figure about 13k should be pleanty for this procedure.
Dec 29 2007,
Almost a whole year went by and I still have not lost any weight and I have been walking for 3 miles every day. Maybe it is portion control with me, I dunno. I just feel sad, hopeless, and FAT. My husband got into a drunken stupor and admitted to me that he was way out of my league and I was really ugly but nice, and he is embarrassed to be seen by me. Man I wanted to slug him, but even though I have never really admitted it that is who I feel about myself. I am not justifying his actions but it was more of a wakeup call because he has never said anything like that before to me. I think it bothers him as much as it does to me. PLUS he was drunk. Something has to happen.
I am now researching Mexico. I would do it in the U.S. but I haven’t found a place that is under 10k. I really need support.
Jan 5, 2007
I must start off by writing Happy New Years!!! I went to the dr today and I got some medicine for my headaches and got diagnosed with GERD. My dr said I have migranes. I just thought it was bad headaches. I weighed in today at 265. Well I am over Tricare criteria for a 5'6" gal. So when I appeal there should be no problem getting approval.
Dec 28, Bad news!! My surgery is cancelled. Tricare wants me to weigh 260 pounds and have a BMI of 40 because my other conditions do not qualify with a BMI of 35. All I could do was cry. Here is something helpful... How to figure out your % over body weight...(Percent Ideal Body Weight = (current weight/ ideal weight X 100) You can find your ideal weight by going here
You will need to find your frame size, Most insurance companies will simply go by the lowest weight for your height by medium frame. If you know your frame size then use the lowest weight for your height as your ideal weight when calculating. When your numbers add to 100% you are at ideal weight. If over 100% then well you are over ideal weight and if under 100% then you are under your ideal weight for your frame size.
Dec 15, 2006
Got a letter in the mail telling me exactly when my pre-surgery appointment is and when my surgery is. It also had my liquid diet info. I am a bit excited that my day is coming up.... oh one more thing it is the 9th not the 8th. Now I need an eyebrow waxing, get my nails done, and maybe a facial and pedicure.
Dec. 5, 2006
I got a call today letting me know that my Doc had to move my surgery Date to January 8th because of the New Year holiday. I can understand.. but I still wasn't that happy about it, lol.
November 30, 2006
Woohoo! I got a date of January 2, 2006. I found out my NUT was fired and we are getting a new one... so I may not have to eat only organic food after all. hehehe. I am still waiting on my pre-surgery date and teh results from my H.Pylori test. I felt like a dog going to the VET for that one; they wanted a stool sample. Things that scare me right now is the tubes I will need, breathing tube, draining tube, NG tube. Yikes i pray that I don't flip out. So, I realize my font and color has just changed.... oh well. I sort of like it. I also need to be eating very low carbs and 2 weeks before my surgery I need to be on a liquid diet. I was told by my NUT 3 protein skaes a day and that is all. I just know I am going to starve~ everyone else seems to not have to just drink that but get at least a plate of veggies. Soon, I am going to get my eyebrows waxed and my nails done and maybe my feet too. Hey if I die during or shortly after surgery, I want to make sure I look good. I know that was a bit vain, but that is how confident I am about the surgery. Secretly, I think my husband is going to test my limits, like giving me sugars just to see if I dump or really fatty things. But he always surprises me. so who knows... Yeah I realize I am just rambling on.........
Nov 13, 2006
I called the dr office to see why I haven't gotten a date yet. I was told that there are many more patients waiting for at leat a year. I replied with yeah I know but my surgery was approved by Tricare as of August, I think it would have been more productive to schedule me a date 3 months out at that time. I don't think they liked that response. Then they said I don't see your psych eval.. and that is going to take some time to get done, so I asked if that was all that I was missing and she said yes. So I said hold on I have copies of everything let me fax it to you. (I have a fax in my home) I heard it come in when I was on the phone. But by that time she just found it. I am doing other tests just to supplement but not becuase it is madatory. Still waiting. I hope they tell me by the end of the week.
NOV 1, 2006
I visited the NUT and my Doc. My But was a little concerned at the fact that I brought my kids. OH WELL. My husband is in the military and I have to do what I have to do and that includes bringing my kids. I already went to a few Nut’s B-4 but she wanted to go through the whole bariatric eating regime according to her. Like I can ONLY eat organic foods. YEAH RIGHT! I don’t have that much money. Now if I do have the extra money I will splurge on organic.
When I met with my Doc She said all looks good and to have the front desk schedule an appt for my two week pre-op and surgery date. They said they will call me back. I did get some freebies today- woohoo- love those freebies!
Oct 6, 2006
I went to my first seminar. Basically it was the same stuff I read about and learned from everyone else. The only new things I learned was how to accurately pronounce some of the words. Plus I also got to meet the surgeon and she impressed me quite a bit. She was very friendly and approachable and by her overall presance I felt comfortable knowing I had chosen a good doctor.
Well, I am officially approved. However the weird thing is that I am supposed to have 8 office visits and 5 hopsital visits. I have neveer heard of it like that. I have an apt for OCT 5 with Dr. Frantzides. but that was cancelled. My insurance called me and told me that my network dr would be Dr. Siegal. I made an apt to see him and the soonest I could be seen is Nov 9th.
Spet 26, 2006 here is my pcp letter. All he needs to do now is fax it to Tricare.
I am writing to you regarding my patient, Ginah spouse of sponsor ########
I am requesting an approval for gastric bypass surgery for Mrs. , a morbidly obese, medium frame female, who is 5'7" tall with a weight of 247 pounds and a BMI of 38.7. Since 2002 Mrs. has been gaining an extensive amount of weight. Mrs. has a few co-morbidities. They include Non Alcoholic Steato Hepatitis (fatty liver) high cholesterol, high triglycerides. These are all results of her morbid obesity. If she does not receive this surgery very soon, we may be looking at many more complications than she has now. Gastric bypass surgery is Medically Necessary for. Although she has been obese for most of her childhood life as well as her adult life, she is now at the stage of Morbid Obesity and cannot afford to continue to gain anymore due to health related risks. She has been unable keep the weight from increasing despite numerous attempts with a nutritionalist and exercise programs.
Her family history is significant for high blood pressure, stroke and heart disease. Her father, who is Egyptian, had many health problems including heart disease, hypertension, high cholesterol, heart attack, arteriosclerosis, and a femoral artery graft at age 31. He died at age 36 after suffering a heart attack. Her mother, who is Native American from the Sioux tribe, suffers from hypertension, sleep apnea, high cholesterol and Diabetes. There are also significant health problems with siblings and grandparents.
Mrs. has made repeated attempts at weight loss, including medically supervised, Ediets for 82 weeks at a total cost of $410.00, as well as enrolling into the health and wellness center on base as advised by her nutritionalist. She tried on her own slim fast, optifast, and weight watchers with little improvement to her weight and more importantly, little improvement to her overall health. Mrs. also needs to buy a bigger size of clothes every 2-3 months because of her weight issues and is now at size 22. Due to some very personal issues she could not attend the fitness classes on a daily bases and was advised in Oct of 2005 to get some sort of fitness machine in her home while with the health and wellness program. She purchased a Treadmill for $375.00 as well as a home gym for $1849.00.Each time she would achieve a loss no greater than up to 11 pounds in a 3 month period, she would regain the weight lost and gain more weight usually double what was initially lost.
I believe Mrs. is a good candidate for gastric bypass surgery and that her case is one of Medical Necessity. Many of her health problems would terminate by such an intervention and the permanent loss of one hundred pounds would definitely help with her future health.
About me: I have Nonalcholic Steato Hepititis and as of 3/14/06 was diagnosed I also have high Triglycerides and high cholesterol.
July 21, 2006
Not much is going on. I keep getting lab tests for my liver and I was just told by my PCP to contact my next PCP in Illinois for Bariatric surgery. In about a month I will have moved to Illinois. I was going to have the DS and pay out of pocket, but With all that is going on in my life I may just have to go with my insurance carrier and get the RNY.