Anyone Size 48 Bougie?
Repost of PilotPhil
Bougie Math
There is a lot of discussion about bougie size on this forum and admittedly, I’ve been concerned about it as well. My surgeon uses a 40 Fr bougie which is the largest size I’ve seen discussed unless, of course, the surgery is part of an additional procedure.
I decided to do some bougie math to get an idea of the differences between the extreme sizes of a 32 Fr bougie and a 40 Fr bougie. Fasten your seatbelts.
The actual diameter of a bougie is somewhat elusive but I’ve managed to find the following: A 32 Fr bougie is 10.4 mm (millimeters) in diameter and a 40 Fr bougie is 13 mm in diameter (1 Br = 0.325 mm). This is a difference of 2.6 mm, which is slightly less than 1/8th of an inch between the smallest and largest!
The sleeve can be thought of as a cylinder. The formula for the area of a circle is Pi * r2(squared) and the volume of a cylinder is simply the answer times the height (h).
I don’t actually know how long a stomach sleeve but I found one source that said it was roughly the same length as the distance between your thumb and pinky finger. That distance for me is 22 cm or just under 9 inches.
Now, it’s just plain math. Don’t forget to convert the diameter to the radius by dividing the diameter by two and converting height from centimeters to millimeters by multiplying by 10.
The volume of a 32 Fr bougie is 18,679 mm3 (cubic millimeters)
The volume of a 40 Fr bougie is 29,186 mm3 (cubic millimeters)
The difference between the two is 10,507 mm3 (cubic millimeters)
By conversion, the difference is 10.5 mL which is 1/3 of one of those little plastic cups on your liquid Tylenol or Nyquil bottles. 10.5 mL is roughly 2 teaspoons which is about the volume of 1 small spoon in your silverware drawer. You could also conclude that the difference between a 32 Fr bougie and a 36 Fr bougie is 1 teaspoon.
The bottom line is that the difference between a 32 Fr bougie and a 40 Fr bougie is one small spoonful!
Even with this information it is not entirely fair to compare bougie sizes since some surgeons sew over the staple line while others do not. Additionally, from watching a few surgery videos, it’s not an exact, smooth staple down the length of the stomach. Some areas are wider than others and some doctors will staple closer to the guide than others.
One last thing to consider is that smaller isn’t always better. Those with smaller stomachs may be more susceptible to strictures, twisting as well as acid reflux discomfort.
I am no doctor but then again, none of us are. I didn’t do this to cause trouble or start a fight about bougie size. After going through this my conclusion is that the discussions about one size versus another are largely overrated. I plan to take my big ‘ol 40 bougie sized stomach home and live happily ever after. If I get to eat one more spoonful of food I’ll learn to deal with that as well.
Repost from PilotPhil
My biggest concern for Marshall is not considering size. It's the fact that he keeps coming back to the question how can he eat more. If you've followed his posts, it's the recurring theme. So I think this is going to turn out badly for him.
But in my defense look at this study...this is the 2nd one that backs up an argument on size. And no I am not going now from 48 to 60. I am just searching and researching and asking. I also admit until recently I did not know there were options on this.
When you look at what I will eat (which is very limited) and what I won't eat (which is broad) I believe that along with the fact I make my living from selling food...pizza at that...I think there could be a good reason to give me a little more room BUT no matter what my capacity is going to be extremely reduced. Big time reduced and that's what I want. I just want to eat less.
Parikh M, Gagner M, Hea**** L, Strain G, Dakin G, Pomp A.
Section of Laparoscopic and Bariatric Surgery, Department of Surgery, Cornell University Weill College of Medicine, New York Presbyterian Hospital, New York, NY, USA.
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has been increasingly offered to high-risk bariatric patients as the first-stage procedure before gastric bypass or biliopancreatic diversion or as the primary weight loss procedure. The bougie size has varied by surgeon during LSG. The aim of this study was to determine whether short-term weight loss correlates with the bougie size used during creation of the sleeve. METHODS: We retrospectively reviewed the data from all patients who had undergone LSG at our institution between 2003 and 2006. Revision LSG for failed bariatric procedures was excluded. The data analyzed included preoperative age, body mass index (BMI), bougie size, and percentage of excess weight loss (%EWL). RESULTS: A total of 135 patients underwent LSG during the 4-year period. Most of these patients (79%) underwent LSG as part of a 2-stage operation (either gastric bypass or duodenal switch within a mean of 11 months). The mean preoperative age and BMI was 43.5 years and 60.1 kg/m(2), respectively. The mean BMI and %EWL at 6 months was 47.1 kg/m(2) and 37.9%, respectively. The mean BMI and %EWL at 12 months was 44.3 kg/m(2) and 47.3%, respectively. When stratifying the %EWL by bougie size (40F versus 60F), we did not find a significant difference at 6 months (38.8% versus 40.6%, P = NS) or 12 months (51.9% versus 45.4%, P = NS). CONCLUSION: LSG results in significant weight loss in the short term. When stratifying outcomes by bougie size, our results suggested that a bougie size of 40F compared with 60F does not result in significantly greater weight loss in the short term. However, longer follow-up of the primary LSG group is required to determine whether a difference becomes evident over time.
PMID: 18656834 [PubMed - indexed for MEDLINE]
The conclusion that they drew did say short term. They did not say what short term meant, but it sounds like what they are really saying is that for the first year it doesn't matter. It's the years after that ...
If nothing else for the sake of this thread and my searching all options the study proves I am justified.
You might turn out to be right on your opinion. Maybe the DS folks will turn out to be right about VSG'ers in general.
I just want to turn out skinny - loving life and being normal.
Did you watch Cirangle's video presentation. He has a chart of the studies comparing bougie size and weight loss over the years.
Except for one reasearcher, RA Weiner, they all show results get worse with increasing bougie size. I've been trying to get a copy of the Weiner paper, to see what they are doing to achieve such great results. Unfortunately, I haven't been able to find it.
