Dr. Cirangle stated in the live VSG that 32 bougie should be used...

or the person won't lose the amount of weight they need to.  My dr uses a 40.  Am I in trouble???

That is his opinion and that is his opinion based on his evidenced based research.

That being said, we have folks here with 32s who NEVER got to goal, and we have folks here whose surgeons used a larger bougie and have more restriction than some folks whose surgeons used 32s.

If you use the size of your stomach as your babysitter, yes, probably trouble is on its way. If you make conscious choices about the *quality* of the foods you eat and teach yourself that SOME is enough - just because  you CAN eat the whole 6 ounce sub doesnt mean its the best choice, you know?

Perhaps for some folks, they just needed surgery to deal with the portion issue, some of us have combo platters in terms of *why*  we needed surgery,  and just a smaller stomach alone wont fix it.

No matter if its a 32, ,28, or a 52. 

My totally un-officially-educated opine is that the CHOICES we make about the foods we consume and the behaviors we engage in are what will get us where we want to be and care to stay.  Perusing this board, the main board, the revisions, and the failure boards has shown it pretty clearly *to me.*

I have a 40 and little restriction. However, my doctor has used 40 for people who are very successful. I mean really the difference between 2 and 4 ounces isn't that much. I look at it this way, my tool is less extreme starting out but I won't have a huge gain in appetite in 6-12 months either. I have had to discipline myself early. Sucks and I lose slower but that's all due to my own choices. The sleeve helps enable choices but won't make them for me. (somedays I wi**** would make them for me!) :)

 Don't count on not having an appetite gain.  I too have a 40 and at 2+ years post op, I can eat a lot more than people also 2+ years out that have a 32f.

I have had a huge gain in appetite and it takes a lot more effort to make good choices all the time.  It certainly can be done but takes more awareness.

My opinion on this subject has evolved over time.  I do believe that during early weight loss, it doesn't really matter what size stomach you have, but in later weight loss and and especially in maintenance, I do believe it matters.  Notice, I didn't say boughie size, I specifically said stomach size.  I now believe that there is more involved in determine the size of your eventual, healed stomach than just boughie size.  There is the technique of your doctor, how tight they pull around the boughie, whether or not they oversew the incision, how close they cut to the top and bottom of your stomach, and of course the length of your stomach.  All these things contribute to the size of your eventual sleeve.  I have met people that supposedly had a 32F sleeve and can eat tons of food and others that had a 40F and are still quite restricted.  When I was choosing a surgeon, one of my criteria for my choice was the size of stomach the surgeon makes.  Dr. Cirangle is known for making a tight and healthy stomach.  Years out, I feel I made the right decision for me, whether you are in trouble or not, at this point will mostly depend on your choice of eating program, compliance, and long term determination.  I would focus on making sure that you are eating well and are working on head issues around food and not worry about the size of your stomach at this time.  Whatever you have is what you have, it is counterproductive to worry about it now.  Make the very best long term choices going forward and you can win.

 

Dr. Cirangle is one surgeon. The link, below, is a link to the consensus on 'Best practices' published last year following a panel review by VSG surgeons. 

 http://www.soard.org/article/S1550-7289(11)00764-7/fulltext

 With regard to Bougie Size:

Sizing the sleeve 

Consensus was reached on critical points regarding sizing the sleeve. The panelists determined that, in addition to it being important when performing LSG to use a bougie to size the sleeve (100%), the optimal bougie size is 32F–36F (87%). The panel arrived at this consensus over concerns that using a bougie 36F could lead to the lack of long-term restriction and possible dilation of the sleeve, resulting in failure of weight loss or long-term weight regain. Invaginating the staple line with sutures might result in temporary or permanent reduction of the lumen size (83%), depending on the suture type used (absorbable versus nonabsorbable).

I didn't want to know this, because I felt like no matter what most of the battle would be mine.   Really I think it is too.  It's up to you. You can out eat any surgery.   I read the surgeons report and found out I'm a 34f... uhhh...why did I do that....lol.  

I have a 38f, but I agree with a previous poster.  Its a lifestyle change and based on the choices you make, not the size of your tummy will determine your success!

Good luck

Agree with so many here.  Smaller is almost certainly better, statistically.  And Dr. Cirangle could do a 32 oversewn on me any day.  But many of us (including me) have lost all our weight at least once with our full-size stomachs.  So that's proof that at the end of the day, it's what we eat and not how much our stomachs can hold.

I really think my biggest problem was that I had more hunger than I could manage on my own.  No doubt, some was psychological and believe me, I have a lot of food issues.  But some was physical, and I think whatever part bougie size or stomach size plays in that, I am a confirmed believer that removing most of stomach did a world of good for me.  And I'm not one of those that lost my hunger.

I have seen way more people say they wish they had more restriction and a smaller sleeve at one year out than I've heard say, wow, I wish my stomach were bigger.  I *know* have more capacity than many folks with tiny sleeves, and sometimes I wish that two ounces of food (not just two ounces of protein) filled me up.  I actually asked for a 34 instead of a 32, because I feared I would never be able to eat a small-normal amount of food.  I know a little more now, and I wouldn't have been afraid of a smaller sleeve today.  But it is what it is, and I am miles, no, light years ahead of where I was before.

I know this isn't much of an answer, but I'm just trying to say, it's what you make of it, and if you believe sleeve size (restriction) is really going to be important for you to maintain, then it would be worth finding a doctor who is good at doing a smaller sleeve.  If you're up to doing more of the heavy lifting, so to speak, then honestly, it might not matter.  I promise I could eat 3000 cal/day on a tiny little Cirangle sleeve if I got back into the sugar and set my mind to it.

I agree with every word you say here, Happy, every single word.