VSG/Bougie/Capacity: New Findings !!!!!

What does it matter what anyone THINKS about how it matters? The medical research shows that it does not. Our thoughts don't matter. 

Eppur si muove.

Until I see a large significant ASMBS approved study of specifically VSG patients and bougie size/technique results, I won't believe it doesn't matter at all. It may not matter much for weight loss, which has been shown, but I sure as hell bet it matters in long term maintenance. The EWL may be the same at 2 years out regardless of bougie size/technique, but I want to see EWL at 5 years and if bougie size matters in a large study. I am sure that it does, but of course, I have no proof and neither does anyone else that it doesn't matter IN THE LONG TERM. That is the key here. The 2-3 years that show it doesn't matter aren't impressive to me. It's the later ones I'm waiting for. And I don't consider an RNY study to be relevant to a VSG. A pouch and intestinal rerouting is completely different.

Professional statistics nerd/number cruncher/etc. chiming in here.

>> OH has a very broad sampling of VSG patients and after you've been here a while you see trends.

Yes, there are many people who post here. I'll bet you five bucks that it's not a mathematically representative sample of all bariatric patients at ANY stage post-op. WAY too many variables unaccounted for; all you're seeing are patients who've somehow found this board (bias towards youth and higher income/education, since you need to be computer savvy), actually post (so no counting the lurkers), and stick around for any amount of time (weeding out successful "graduates" or those who have enough difficulty that they disappear).

Do you see trends among the posts here? Sure! Are they based on consistently-measured indicators? Does each case have a clearly-identified outcome?

Bottom line: if you're trying to draw conclusions from posts seen here-- or anywhere else on the Internet, for that matter-- you have anecdotes, not data. You might as well be comparing apples to oranges to kiwi fruits to pineapples to a whole pile of seeds, Heaven knows what kind of fruits they might grow into, and a big pile of mushy fruity compost to boot.

>> I'm not asking you to believe me, just asking you to educate yourself and give this thing your best effort !!!!

If you're asking people to educate themselves in a specific way, the best way to do so is by pointing them towards useful research (double-blind is awesome, but controlled case studies seem to be the best we can do for WLS from the NIH at the moment) rather than ambiguously suggesting that people "look it up."

Since you've seen it all, could you pass along your research links? I'd love some new data to run through Excel-- came up with some neat new chart templates recently-- and it's been a while since I dug through PubMed looking for anything new. TIA! :)

Hmm, I had no idea asking for clarification was block-worthy. So much for research :(

I asked the bougie question earlier and got feedback and some good  one's too. Good thing I do my own resarch and fully rely on forums. 

I do not know my bougie size.

I'm ok with that.

I think studies are important things, here's one that has been referenced by ASMBS and referred to in their updated information to the surgeons.  This was from the update to the 2012 report.  I will not paraphrase as I do not want to be misunderstood, but they looked at their national VSG figures from 12 different centers where the VSG was performed differently.  Their conclusions should be interesting to those looking into sleeve surgery and completely irrelevant to someone who already had it done.

http://drbaltasar.es/pdf/215.2009.02.%20Raquel-Baltasar.CB.Sleeve%20Spanish.pdf

The whole article is interesting to me, but the part that is best considered for evidence for Frisco's point can be found in Table 5 and the discussion that follows.  Yes, I do believe that hormonal changes are a huge part of our weight loss but capacity plays a big part in the long term.  The two work synergistically to help us lose and maintain.  It was also interesting to me that they talked about surgical technique as being a factor in the early weight loss.  I suspect that there is more to this when it comes to reducing GERD and other important functions of the sleeve.  

Sometimes, Frisco, you can be a bull in a china shop.  I still love  your threads, and consider them required reading.  

Interesting - thanks for the link!  

table 6 shows ewl almost as high in 32f as in 48f  and it seems that some of the larger sizes have more complications

I feel and Im not a medical professional  that 1 size bigger or smaller matters little , surgical skill  is more important

 and a great food plan the most important, except maybe a great support system 

 you can lose with a 40+ and gain with a 30f it depends on how you use your tool

 age also is a big factor , older people lose slower , larger bmi people take longer to reach goal

the answer is to use the best surgeon you can , and trust him /her to make a great sleeve that will work with how to are built inside ,

 a real long 30f sleeve will hold alot more than a real short 36f and everyone's stomach starts out at a different size

 in general very small sleeves have more complications so if you want one make shore you go to a great surgeon at makes great small sleeves

I think it is time the ama starts to standardize these surgeries

 any md can legaly do wls , just like plastic surgeries there are some real quacks out there that hurt the reps of these surgeries

if your looking to have weight loss surgery , do your research , find a surgeon with a ton of experience  at the surgery you want  , talk to him/her about how he/she does the sleeve, what starting size, what expected size at 1+ years

 what expected weight loss , how many and what kind of complications and how they where fixed

I think this topic is over done , and you rather people talk of surgical skill than surgical tool size , ps some surgeons don't use a bougie

*Like*

Surgical skill is a whole other subject. Some refer to VSG surgeons as just "cutters", well that minimizes the skill level needed to cut the proper shape to insure positive food flow and minimize reflux issues.

frisco