Vertical Sleeve – Does Bougie Size Matter?November 3, 2016
Vertical Sleeve - Does Bougie Size Matter?
The Vertical Sleeve Surgery Calibration Tube
The calibration tube is made out of soft and flexible silicone with the capacity for internal aspiration. This serves to aspirate the stomach during vertical sleeve surgery. It is inserted through the mouth once the patient has his airway secured to avoid the risk of aspiration pneumonia, the anesthetist introduces it into the stomach and the surgeon fits under direct vision. There are different tube sizes and it is measured in Fr units; 1mm equals 3 Fr units. A simple way to know the diameter in millimeters is to divide by 3. For example, a probe 36 Fr equals 12 millimeters. Most flexible endoscopes have a diameter of 9.8 mm, that is why in some cases they are used as calibration tubes.
In a gastric sleeve, the calibration tube is extremely important, not only to prevent a wider sleeve but also to avoid areas of stenosis and achieve a gastric sleeve in the most appropriate way, since these two conditions will determine weight loss results as well as the quality of life of the patient.
The Calibration Tube Size and Insertion
The size of the tube is only important if when stapling the tissue, the stapler is used right next to the probe as a real tutor or guide. In some cases very small calibration tubes are inserted but the surgeon places the stapler very far from the tutor, this leads to very large areas or gastric bags and/or areas of stenosis elsewhere, which can lead to inadequate weight loss or funnels that increase stomach pressure and increase the risk of leakage.
Once the size of the tube is decided it is necessary to have a good dissection all the way to the pylorus, in our case we leave the staple line 3 cm separated from the pylorus, this serves to preserve the performance of the stomach valve and avoids having a rather large stomach at the bottom.
The anesthesiologist always verifies that the calibration tube has adequate tension because if you put a lot of pressure it increases the curve of the sleeve, leaving us a bow arrow shaped sleeve which again increases the size of the sleeve or if the tube moves from its place areas of stenosis may occur.
At the worldwide expert sleeve consensus , which our founder was part of, it was agreed that the tubes should be between 32 and 36 FR, this to achieve adequate results and reduce the risk of complications.
For more information on Bougie Size, watch Dr. Campos' YouTube video:
ABOUT THE AUTHORDr. Wilhelmy is a highy skilled surgeon wtih over 18 years of experience in Bariatric Surgery has done more than 5,000 succesful laparoscopic surgical procedures. He currently works with the specialized and professional team of medical specialists at Mexicali Bariatric Center. Dr Wilhelmy was a pioneer in Weight Loss Surgery in Mexico and he has continued to perform advanced bariatrics. Having been a surgeon for over 27 years, he has seen all types of scenarios in the OR.
ABOUT THE AUTHORDr. Edgar Campos is a clinical bariatric doctor and nutritionist with over 10 years of experience with pre-op and post-op bariatric patients. He also supports patients with non-surgical options for weight loss such as the balloon procedure and nutritional guidance. Dr. Campos practices medicine at Mexicali Bariatric Center as the medical advisor and bariatric doctor. He is an 8-year post-op gastric sleeve patient himself.
Read more articles from Dr. Edgar Campos!