Panel Issues statement on Sleeve Gastrectomy to Guide Surgeons

http://www.generalsurgerynews.com//ViewArticle.aspx?ses=ogst&d=Obesity+Care&d_id=410&i=ISSUE%3a+June+2012&i_id=857&a_id=21049

My dad emailed this article to me from General Surgery News.

Fascinating article.  Thanks for sharing.

 Thanks Chana! I needed this info. I had some misgivings when I met with my surgeon last week. He said he had just come back from a conference where it was decided that 40f was the safest boughie size because the rate of leaks goes up as the tube size goes down. That freaked me out because one of the surgeons I respect uses 32f. 
I feel better hearing this info from more than one source.

Interesting because that isn't what this panel decided:

"The panel came to agreement on optimal bougie size, saying that a bougie between 32 and 36 Fr (87%) is ideal. They cautioned that a bougie less than 32 Fr might increase complications and a bougie larger than 36 Fr could lead to a lack of long-term restriction and possible dilation of the sleeve."

(my emphasis)
It is such an area of controversy, but so many people on these boards get a 32fr with no issue, and skilled surgeons can do the 32fr with a nearly zero leak rate, I wouldn't let one opinion make up your mind.

But if your surgeon wants to stay bigger, I wouldn't try to talk him into a smaller size because he is telling you where he is technically comfortable.  Just find another surgeon who is more comfortable with the bougie size you want.

I think she was referring to this portion of the article: 

"Studies presented since the panel’s consensus suggest that bougie size can be larger than 36 Fr, said Michel Gagner, MD, clinical professor of surgery in Montreal.

Two meta-analyses presented at the International Federation for the Surgery of Obesity and Metabolic Disorders meeting in September 2011 showed that bougie size below 40 Fr resulted in higher rates of leaks and bioabsorbable buttress material had decreased the rate of leaks by threefold.

'I would suggest surgeons should use a bigger bougie size than in the consensus statement,' said Dr. Gagner."
 

Not what the panel decided, but stated in the article. 

 I don't know.  The part you bolded really jumped out at me too.  I have the larger size and it is a beautiful thing at the moment.  However, my capacity is certainly increasing where now I can eat a "normal" sized meal.  I can't overeat like back in the day, but tonights dinner was 4 ounces fish, 1 cup of mango spinach salad, and a serving of sauteed zuchinni.   

I super appreciate you posting this article because it really hit home for me that I will have to be long term dilagent in maintence (more so then the smaller sleeved friends here). 

Thanks :)

And for the record, if I had to do it over I would not use the smaller sleeve size.  Only time will tell if I will change that opinion once maintenence hits.

Great feedback HappyTeacher!

It's wonderful to hear from someone who has had a larger sleeve. At this point, I don't know how I feel about a 40f vs. a 32f. My understanding is that the difference is about two and a half centimeters.
If 40f is 12.738 cm and 32f is 10.191 cm (dividing by pi).

I wonder if those that have had a leak would have opted for a larger sleeve. My first instinct is to think like you...Smaller sleeve=greater weight loss! Also, a smaller sleeve can't expand as far when the honeymoon is over.

This is my take on this whole thing.  I believe that some surgeons should not do a smaller stomach as it takes greater skill.  If every single surgeon would use a smaller boughie the number of leaks would go up.  On the other hand, there are plenty of surgeons that have improved their technique over time and now use smaller 32f boughie's and have some of the lowest leak rates in the industry.  The idea that there is a very small difference is size does not take into account what happens after the stomach heals.  It is precisely this tissue that stretches the most and lead to a significantly larger sleeve as can be attested to many people on here.  I believe that you can have your cake and eat it too by going to a doctor that makes small stomachs and is an amazing surgeon with very low leak rates.  At three years, I am certain that I would not want a bigger stomach.  It would make maintenance much harder for me.  You have to remember that most surgeons consider 50% EWL to be a success, my doctor disagrees and wants to see 80-100% EWL.  That is a huge difference to me.  I don't really have a dog in this fight, I am already at goal but I know where I would send my family or friend. 

 Thanks for responding Elina! 
I have read your previous posts on bougie size and I have watched your surgeon in action. Facinating! Dr. Cirangle is an artist. I was referring to him as the surgeon I respect in my initial post. I was a little surprised when my surgeon talked about strictures and leak rates

Dr. Cirangle has one of the lowest rates of leaks or strictures yet he makes one of the smallest sleeves.  I would not recommend asking a surgeon to make a smaller sleeve as it is much harder to do correctly.  On the other hand, I do believe that your surgeon is correct, overall smaller sleeves made by the majority of other surgeons carry higher risks.