Is there anyone here that knows or understands why there is a difference in the amount of stomach reduction from one Dr to another. I have attended a seminar- orientation with a local bariactric center, they stated that they remove 90% of the stomach with VSG. I have watched tons of videos and advertisements ranging anywhere from a 70-90 % reduction. Is this physician preference or based on the patients BMI?

Wonder how or if this does this effects the outcome of how much weight you lose or how long it stays off.

Thank you in advance for your response. Happy!!

Not certain, but guessing that most doctors tend to go with whatever they initially learned, unless they found that it was problematic. Maybe they started with 90% and then someone said, "whoaa, that's too much" so they all started doing 70%, but others started saying I am doing 80% because that is right in the middle. There should be some difference in success based on having less stomach, but 90% seems like a lot, maybe they found that some people's stomachs were too small or subject to strictures so they decided to leave more stomach. Not sure which came first, but most 'info' on VSG seems to say 85%, but that could be an average. It seems that most surgeons list using a particular bougie size which might also result in the difference. If my stomach is smallish (although I am sure it is not) then using the same measure on me and on someone with a large stomach might leave me at 90% gone and them at 70% gone. I don't know that they particularly tailor it to BMI.

Is there anyone here that knows or understands why there is a difference in the amount of stomach reduction from one Dr to another. I have attended a seminar- orientation with a local bariactric center, they stated that they remove 90% of the stomach with VSG. I have watched tons of videos and advertisements ranging anywhere from a 70-90 % reduction. Is this physician preference or based on the patients BMI?

Wonder how or if this does this effects the outcome of how much weight you lose or how long it stays off.

Thank you in advance for your response. Happy!!

I think this has more to do with the differences in your size initially..

The size is based on the bougie, but if you use the same bougie on a person with a larger stomach then you are cutting more percentage away. KWIM?

I have a friend who had 90% removed and about 6 months later had to have the sleeve expanded because she was unable to get in enough proteins. She was very very sick with 90%...I go on June 29 and I requested to get only 80% removed..was then told by the nurse that Dr Almanza usually only takes 80% anyway..but I had to request b/c I knew how bad 90% was for my friend.

I have a friend who had 90% removed and about 6 months later had to have the sleeve expanded because she was unable to get in enough proteins. She was very very sick with 90%...I go on June 29 and I requested to get only 80% removed..was then told by the nurse that Dr Almanza usually only takes 80% anyway..but I had to request b/c I knew how bad 90% was for my friend.

My doctor used a size 40 bougie and said he removed 85% of the stomach. I have no reflux issues at all and neither do 2 other people who used the same doctor. My opinion is that the smaller the stomach the higher inclidence of reflux. I am happy with my outcome. I cannot eat more than a 1/2 cup of food and have been losing steadily.

My surgeon removed 85% of my stomach. I reached goal in just under 5 months and am now maintaining at 14 - 16 lbs below goal. I've had no problems and am eating just over a half cup of food at each meal, filling in with several Snacks a day to get in the 1200 calories I need to maintain. I have a 32 size bougie. I wouldn't have wanted one any larger. I'm really, really happy with the way things turned out!

Is there anyone here that knows or understands why there is a difference in the amount of stomach reduction from one Dr to another. I have attended a seminar- orientation with a local bariactric center, they stated that they remove 90% of the stomach with VSG. I have watched tons of videos and advertisements ranging anywhere from a 70-90 % reduction. Is this physician preference or based on the patients BMI?

Wonder how or if this does this effects the outcome of how much weight you lose or how long it stays off.

Thank you in advance for your response. Happy!!

I think what a LOT of this amounts to us a WAG on the part of the doctor, how much in percentage depends on how much you started with minus the amount that's left, therefore if you started with a BIG stomach then the percentage is greater. The stomach is a notoriously stretchy thing so even that isn't a firm thing either, if you pigged out up til the surgery your stomach is going to be a huge sagging thing, stay on a liquid diet and the stomach will retract.

The LENGTH of the organ again makes a difference, a 5'1" woman probably has a shorter, smaller stomach than a 6'3" man, or even just vary from individual to individual that might otherwise be similar in size.

Regardless what matters is what is left and what you put in it.

How do they tell how much they remove? Do they measure the stomach somehow first then decide what size bougie to use or do they just use whatever size bougie then measure what they cut out or what?

My doctor showed me some long-term stats from his patients with a low BMI to close to mine. She only went from 186 to 156 in weight and he said that was probably because he used a larger bougie back then. Now he uses a size 32 which from my experience is fine-I can ea...er u..actually I've never measured....I can suck back slider foods-but don't unless they are protein shakes and get almost immediate tight restriction with the regular protein meals. After the first month I've had no reflux and as you can see from my ticker I'm getting close to goal after only 14 weeks! He didn't ever describe a percentage because I'm sure that's different with everybody.

How do they tell how much they remove? Do they measure the stomach somehow first then decide what size bougie to use or do they just use whatever size bougie then measure what they cut out or what?

I think the doctors simply standardize on a size and just use it exclusively. I suppose they might go larger or smaller depending on a specific situation but I don't know for certain. One would think if someone already has a super small stomach they wouldn't need the surgery in the first place.

I asked my surgeon this... he said that he tries to find a good middle ground in each patient. He said the trend is to go as small as possible but he finds that this makes patients much more sick at the beginning and that they have trouble getting down anything, which can lead to vomiting which then leads to leaks. So, he said that the stomach was about the size of his index finger.

Also, everyone on here talks about surgeons using bougies. I know that my doctor uses an endoscope instead... and that helps him look for leaks before the surgery is over.

I think the doctors simply standardize on a size and just use it exclusively. I suppose they might go larger or smaller depending on a specific situation but I don't know for certain. One would think if someone already has a super small stomach they wouldn't need the surgery in the first place.

Sure. But how do they actually measure whether they took 75% or 80%? Are they just guessing? Some people have said that their doctor told them he took out a certain percent. I thought it was just an approximation but they sound like the doctor told them specifically. Again, do they measure the stomach before the procedure or do they just look at it and say, "Yeah, I think I just cut out about 80% of that one. That's what we'll go with." Not that it matters to me. I'm just curious how they know.

My surgeon explained to me that they use a tube they run down your throat and into you stomach. The size of that tube determines the size of your sleeve. There are various size tubes and it is the doctor's preference on the size they use. Since each stomach is a different size, then the actual percentage would be different for each person. A larger person may have 90% removed and a person with a smaller stomach would have 80% based on the same tube size. I would ask tube size more than percentage of stomach removed.

My surgeon explained to me that they use a tube they run down your throat and into you stomach. The size of that tube determines the size of your sleeve. There are various size tubes and it is the doctor's preference on the size they use. Since each stomach is a different size, then the actual percentage would be different for each person. A larger person may have 90% removed and a person with a smaller stomach would have 80% based on the same tube size. I would ask tube size more than percentage of stomach removed.

Right. I know the bougie size determines the stomach size in the end. But what I don't get is how the dr. knows exactly how much he has cut away from each person's stomach, being that each person's stomach is a different size to begin with. Let's say there is a 6'6" man that gets a sleeve with a 40 french bougie. Then a 5' woman gets ones with the same size bougie. I would imagine that the dr. cuts away more of the man's stomach than he does the woman's giving them each a different percentage that was removed. But how does he know?

I think they just guess at it. I can't imagine that there's any way for the dr. to know exactly how much he has just cut away other than just eyeballing it. I haven't heard of anyone saying that he does ultrasound measurements before and after or anything like that. So he has to be just guesstimating it. The 75% or 90% number doesn't really mean anything anyway. It's the size of the bougie and the length of the stomach that matters. I would think the 6'6" guy would wind up with a larger stomach than the 5' woman because his is still longer. So the doctor probably cut away a higher percentage of his stomach yet he still has a bigger one than the woman. So the percentage means nothing.

I'm being way too anal about this. But I just wondered why people were suddenly using the percentage number and not the bougie size. I wondered if I had missed something.

There is no way for them to know a percentage because we all have different size stomachs to start with. I did see my video and the part they removed looked huge to me. Without a full volume test befroe and after there is no way to have a specific number--it is a guess. The constant they can do is to use the same size tube in forming the remaining stomach sleeve. However due to stomach length being different remaining stomach volume can differ between 2 people with the same surgeon and bougie size. There are also differences in how close they come to the upper and lower stomach valves that affect both volume and chance of strictures. It is definately not a cookie cutter pattern they follow and why I recommend doing research on your surgeon and discussing these topics with them. Many follow the published studies from the leading VSG surgeons and some do their own thing.