Is size 40 bougie too big?

 
The only thing I will say is that my surgeon has statistics that say his 32f bougie sleeves are far more successful in long term maintenance. He has been doing the VSG for over 10 years and over 2200 procedures. His early patients had bougie sizes of 46 and 42. Most lost weight just fine the first year but the regain was higher than his current 32f.

His 32f starts out with about a 2oz. capacity and eventually matures to around 4oz.

A bougie size 10 numbers higher than a 32 (a 42) can eventually mature to 4x larger....think below or above 16oz.

Many on this board with a 36f-38f claim 8-12oz. capacity.

Of course we have people on this board that have done quite well larger sleeves......which proves patient commitment and compliance is most important. And yes....just cause you get a 32f sleeve does not mean you will be successful. It just means your mechanism has less capacity, but you still have to eat correctly.

And yes....there are some people will larger sleeves do better than some with smaller sleeves.....It is ultimately up to you and how you eat and change your ways....

frisco

Thank you all for your responses, it definitely made me feel better. As long as I stick to my plan and goals, size will not matter! :) Thank you :)

THE BOUGIE SIZE, UNLESS IT IS A 60 OR LARGER, HAS VIRTUALLY NOTHING TO DO WITH WEIGHT LOSS.

Comparing bougie size is like a bunch of little boys going behind the barn to compare the size of their anatomy.  It means absolutely NOTHING when it comes to your success or failure at weight loss.

The ONLY thing that really matters is how well you comply with your diet and exercise program.  The better your compliance, the more you lose.  it is really that simple (some folks will tell you differently, but they are simply WRONG!)

If you do NOT trust your doctors judgement, WHY ARE YOU CONSIDERING ALLOWING HIM/HER TO OPERATE ON YOU?  THAT SIMPLY MAKES NO SENSE AT ALL!

Do you really think your doctor wants to set you up to fail?

I have a 40f and have done well so far. Still don't eat 2 oz at 7 months out.

That said, my surgeon made a nice, tight sleeve. Frisco mentions the importance of bougie size, but I also believe in the importance of technique. A lot of surgeons are leaving a lot of stretchable tissue at the top and bottom of the sleeve near the valves - sort of a barbell shapped thing instead of tight all the way down. This to me is a bigger issue than bougie size within the range of 32f and 42f.

Yes, a tight 32 is tighter than a tight 40. But my tight 40 is a heckuva a lot tighter than a LOT of 32s I'm seeing on the board.

So it matters, but only as one in a number of factors.

Have you had a chance to go to a support group and talk to your surgeon's other patients? How are they doing on loss? How much restriction do they have? If they can eat more than 4-5 oz of dense protein after a year, I'd be concerned. If not, your surgeon may make a nice tight sleeve.

 
Yo mom....

I agree 100%

I just didn't wanted to keep it to the short story......Many many factors go into a proper modern day VSG.

Bottom line....It's harder to make a smaller sleeve. Yes, technique is key.....so is sleeve shape to insure proper food flow.....

Bougie size should not be negotiated......Never push your surgeon for a smaller sleeve.

And to OM...... I agree that it is ultimately up to the patient.....but I respectfully disagree with most of your post.....It obviously matters.....or there wouldn't be different sizes???

frisco

One of the reasons smaller sleeves may do better long-term is that there's less possibility of leftover fundus which is the tissue that produces grehlin which stimulates hunger more than absolut capacity.  At approaching 10 months post-op, my dense protein capacity is about 2 1/2oz.  I can eat about 4oz of cottage cheese, but not more.  I have a 36F and I"m 5'3".  It's likely I have a stomach that's shorter rather than longer than many.  I have also been very careful not to push the capacity of my sleeve.  I also have no actual hunger.

Here are things to consider: 

1) It doesn't matter what size your sleeve is if you graze. 
2) I'm pretty sure I'd have no restrictions with a pint of Ben and Jerry's.  Sleeve size is not a consideration if you start drinking (effectively) your calories. 

Follow your plan and exercise.  

I'm roughly 7 months out. I had a 36F bougie.

I think loosing 114lbs in 7 months speaks volumes. I even fell off the wagon and started to eat stuff I shouldn't have and still lost or maintained. It's all in what you do. You will be fine!! Again, the size is so minutely different that we're talking milimeters. I had my surgeon actually show me in person what I was in for and he explained that because of my height, weight, and size of my body that the larger option was the healthiest way to go. Ask questions, and make them explain to you why. Not just "That's all we'll do". Have them show you in terms of the devices, or in realative objects. You'll be fine! :D

Plus if you ask a lot of us heavyweights for some reason our bougie sizes were generally larger.
I'm not sure if this has anything to do with it.. but it could...

Best of luck to you!  

The Bougie and why there are different sizes:

Bougie: A thin cylinder of rubber, plastic, metal or another material that a physician inserts into or though a body passageway, such as the esophagus, to diagnose or treat a condition. A bougie may be used to widen a passageway, guide another instrument into a passageway, or dislodge an object.

Bougies are available in a wide range of sizes and degrees of flexibility. They may consist only of a simple cylinder. The cylinder may be equipped with such devices as: (1) an inflatable balloon to apply pressure against obstructions or narrowed walls; (2) a gauge to measure the pressure applied by the balloon; (3) a wire that is positioned at the site of a stricture, blockage or another problem to guide other instruments into the passageway; (4) a channel through which dye can be injected so that a site can be identified on a fluoroscope and (5) a light to illuminate a passageway for examination.

Bougies may be used to treat strictures and blockages in the esophagus, the intestines, the rectum, the anus, the ureters (the tubes that transport urine from the kidneys to the bladder) and the urethra (the canal that transports urine from the bladder to the outside). A stricture is an abnormally narrow section of a passageway while a blockage is an obstruction within a passageway.

To remove an object lodged in the esophagus, a lubricated bougie may be used to dislodge the object and move it down into the stomach. The object then passes through the intestines. This procedure is feasible only if the object is unlikely to damage tissue as it moves through the intestinal tract.

Bougies equipped with balloons may be used to eliminate both strictures and blockages in the esophagus. In a typical procedure, a lubricated bougie may be inserted under local anesthesia. When the bougie reaches the site of the stricture or blockage, the balloon is inflated. The pressure from the balloon then can widen a narrowed passageway.

Bougies sometimes play a role in treating achalasia, a disorder in which there is abnormal function of nerves and muscles of the esophagus (swallowing tube) resulting in failure of the lowest-most part (lower esophageal sphincter) to open and allow passage of food. A bougie is used to stretch this sphincter.

Bougies equipped with lights are sometimes used in surgery involving the colon, rectum, abdomen and chest to help physicians view and identify internal structures.

"Bougie" is a French word meaning "candle." The French apparently derived the word from "Bugia," the name of a North African town that exported candles to France. Because a bougie resembles a candle, English-speaking physicians wrote it into medical lexicons to describe candle-shaped diagnostic and therapeutic instruments. It was an apt word, for such instruments originally consisted of waxed silk or cotton rolled into a cylinder. Today, the French word "bougie" can also mean "probe" and "sparkplug." Also, the English "word" bougie can sometimes be used to refer to suppositories like those inserted into the anus to treat hemorrhoids. Related terms include "bouginage" (also spelled "bougienage"), which refers to a procedure in which a bougie is used, and "bougie � boule," which refers to a bulb-tipped bougie.