Hi all. This is my 2nd post...yay!!!

OK, I've read posts where people claim that, for the most part, bougie size doesn't matter. However, I wonder if that is still true for a patient with over 200lbs to lose?

I've searched this forum to find people with over 200+ lbs to lose, but not many people list what bougie size was used on them. I am wondering if their success was at least in part due to bougie size.

Here's my personal dilemma: I am about 99% sure of the surgeon I want to use for my upcoming VSG. He uses 36 fr and oversews (Dr. Ramos-Kelly). However, there is a user on here who's lost well over 200 lbs that went to Dr. Almanza, who uses 32 fr. So I started wondering if perhaps the 32 fr was a better choice. Now, that's not to discount the fact that a lot of hard work weighs heavily into the equation as well. But I'd just like to hear other's thoughts on the differences in bougie size (specifically, 32 vs 36) and those of us with hundreds of pounds to lose. Thanks!

Carla (aka CJ_Redux)

Well, I don't have 200lbs to lose but my Dr uses a 40. I'm not worried about the size of stomach I have because it's more about doing the post op diet and when you see the size differences its very very little.

I hope to lose 175 lbs. Not quite 200+ but close enough I would say. Unfortunately I didn't understand much else in your post.... I think you're talking about how big the stomach is post surgery but I'm not sure.

My surgery is on Thursday. If there's anything I can ask for you to help answer your question, please let me know.

Sent from my SGH-T679 using VST

Bougie is just a # the doc perfers. The amount of food the sleeve will allow is not that significant. You will loose weight just as quickly as everyone else.. You still have a restriction that will restrict how much you eat.

As you can see the difference between a 32 & 36 is minimal.

I have a 38, and I think it is the best of both worlds. I can take six pills at once (supplements), and I never had a problem with drinking liquids quickly to get rehydrated, and I never vomited once other than in the hospital the day after surgery. I feel restriction quickly, but I can take more than five bites. I can eat a whole taco, and that's about it for a meal if I want to. It's a size that I can live with for the rest of my life. The smaller sizes work too, but I think there is more of a risk of strictures and problems with a smaller sleeve. You will lost weight either way, and ultimately, it won't affect your weight loss. I would trust your surgeon's advice.

My doctor used a 32fr, but I'm not sure if it matters. There was a study done comparing a 40fr to a 60fr and they didn't find a difference in the short term.

Someone posted this picture a while back that shows the differences between bougie sizes and it really is negligible.

And bougie sizes in inches:

32F = .40"

34F = .425"

36F = .45"

38F = .476"

40F = .5"

46F = .576"

60F = .75"

I would say if you're comfortable with the surgeon that is the most important part, but if you're concerned I'd discuss it and see if he'll use a different size or at least stay close to the bougie when making the cut.

Here's another view of some bougie sizes: http://www.medovations.com/pdf/Esophageal_Dilatation.pdf

CamarilloCA,

That was an interesting link! Thanks for posting.

My surgeon also brought up a good point when I asked him about this. He said that the bougie is just a guide. Most surgeons are not leaving you with a stomach the exact size of the bougie, no matter what size it is. It's simply a guide to make sure they don't staple too close and risk stricture.

Thanks all for the replies. I guess this issue for me comes from the fact that the weight loss will slow after a while. I was fearing that with a larger bougie, the weight might slow down faster. But i'm probably worrying for nothing, since there isn't much difference between a 32fr and 36fr. I just really want to get the best results possible, because I have so much to lose. Working out is not a problem for me, but I NEED restriction. (I never met a carb I didn't like! )

I will discuss it with the surgeon also, just to put my mind at ease.

Long term, anybody can stretch the stomach out, just do you're best and be conscience of what & how much you eat & you will do great.

I didn't read all of the posts above so hopefully i'm repeating anything. I don't think it really matters. Every surgeon is different. Say you have two surgeons who both use the 32. One surgeon might make it a "tight" 32 where he staples as close to the bougie as he can, while the other uses it more as a guide. The size of your stomach also depends on YOU. If you are tall you're stomach is more likely to be longer... so you're sleeve will be a bit bigger.

Also, the difference between them is literally millimeters. Someone posted a picture a long time ago that showed the size, and it was the difference between a pencil, a pen, and a thin highlighter or something like that.

My surgeon used a 42. He explained though that he makes a "tight" 42 where he goes right up against the bougie and then he over-sews as well. I am 8 months out and I can eat 2-3 oz of Protein.

I don't think it makes a significant when it comes to the amount you lose. Each person is individual. I highly suggest you go with your gut. Go with the surgeon that makes you feel the most safe and comfortable.

I just had surgery 12 days ago with Dr Kelly and he and I had this conversation right before I went into surgery. He was very confident and matter fact with his reasoning for the size he uses. You will love Dr. Kelly.

The size of your stomach also depends on YOU. If you are tall you're stomach is more likely to be longer... so you're sleeve will be a bit bigger.

That's part of my worry. I am relatively tall (5' 8", with a longer torso). So I have a feeling my stomach will hold more in general.

I highly suggest you go with your gut. Go with the surgeon that makes you feel the most safe and comfortable.

Sound advice!

I have/had over 200lbs to loose and spoke in depth about this topic with my surgeon who assured me no matter what I read/wanted he was going to do what he was comfortable with. He then explained the difference is so minimal. You will loose weight regardless of bougie size and the smaller you go the more chances of problems you will encounter such as leakes, vomiting etc as other postings will confirm.

You can research and over research but ultimately you need to trust that your surgeon will make the right decision for both of you. I'm sure you will be fine.. good luck!