I know, odd question and maybe I can over thinking this too much but you can never be too infomred right?!

I have about 70 Lbs to lose at a MBI of 33. I keep reading how the extremely low amount of food consumption for years following surgery and how FAST sleevers are losing weight. Why doesn't it make more sense to go with a larger pouch/bougie which should help with food tolerance, still give a large amount of restriction, and level out the extreme front end weight loss?

I have read bougie sizes can range from 30-40.

Are there any opinions out there? What about you low BMI-ers? what say ye?

I started out needing to lose 66 lbs. I was a low BMI-er. My bougie was 36. I believe 32-34 is more common. My doctor feels 36 has less complications a lower risk for leaks. Aside from the day of surgery, I didn't have any problems getting my fluids down. I'm not one of sleevers that could only eat a couple of bites. I've been eating at least 4 oz since the mushy stage. I can eat about 6 oz now. I've always been a slow loser plus I'm a revision. I wish my weightloss was faster but, I'm happy I didn't have any complications or issues getting enough water & protein in. I don't think you're over thinking it. I think it's something important you should discuss with your doctor. Good luck.

This is my thought exactly! I would like a loose 36-40. loose in that even with the initial swelling that fluids would be easily tolerated. But it may defeat the purpose. however the gherlin would be gone and say 60-70% of the stomach gone instead of 85%. This would also in theory cut down on reflux also. Just curious. Dr. Kelly uses a 36 per Omar.

Yes I think a stomach volume of 4-8oz after swelling gone would be good, preferably 6-8oz Im thinking. Told omar something similar. May try to contact Dr. Kelly to see what he says.

Great posts and thank you for joint in!

My doc is using a 40 French boogie from what I understand. Let me know what you find out!

There was a pic floating around awhile back that showed the difference un the various bougie sizes. You'd be surpried how very little difference there is in them. I think the bougie size we refer to is in millimeters. So a 34 bougie would be only a tiny bit bigger than a 32.

My doctor said it is not so much the boogie size but it is how close the doctors staple to the boogie. He says he uses a 34 but staples out from the boogie.

Honestly a 32 and 40 aren't that much different at all! We are talking small differences! See the image below.

I'm going to ask my Dr but It isn't a huge deal to me if he goes with a 32 or a 40. I know I will lose lots of weight and get to Goal within a year no matter which one he uses and as long as I eat slow and drink a lot I will be ok.

Johnathan

Yeah, thats what it appears so can you see my point? Why not go a little larger. I mean, why not go to a 50?

The best would be to ask a surgeon about why that is not a good idea. But, I cant imagine restriction of 70% of stomach capacity being nearly as effective, if not more healthy, than 85% rstriction. The other question is how that would affect the production of the grehlin hormone (AKA Gremlin, dont eat after midnight, you might not like what you turn into)

I guess my queston is, why go as extreme if the need is not as great?

This is apre-emptive strike. I KNOW there is no other way for me to get back to a healthy weight. I have tried all other options. Are there and success stories of different "degrees" of getting sleeved?

My dr used to use a 34fr bougie, but then switched to using a 38fr bougie. Was seeing better results health wise. Paitents did better with a larger bougie.!

My dr used to use a 34fr bougie, but then switched to using a 38fr bougie. Was seeing better results health wise. Paitents did better with a larger bougie.!

Who was your surgeon?

There was a pic floating around awhile back that showed the difference un the various bougie sizes. You'd be surpried how very little difference there is in them. I think the bougie size we refer to is in millimeters. So a 34 bougie would be only a tiny bit bigger than a 32.

you are correct in the size is close. it takes 25.4mm to make 2.54 cm which equals an inch. It is the staple line that matters and how close it is to the bougie.

Who was your surgeon?

Dr Mason. Bryan, Tx.

I'm also not so sure the "size of tr bougie doesn't matter" logic works either. I'm not sure what the numbers stand for, but if they are for diameter size then the VOLUME difference between a 32 and a 40 is about 50%.

I assumed (incorrectly I'm sure) that a stomach is 5" long. Even though that number is certainly incorrect, when talking volume of a cylinder there is a large difference in overall volume.

A little more info:

The size of a bouge is the # of mm x 1/3. So a size 40 FR bougie is 13.3 mm in diameter, or a radius of 6.65. The stomach, after being sleeved will resemble the shape of a cylinder.

If you take the volume of a 40 Fr bougie and compare it to the volume of a 32 FR bougie, there is about

Formulas:

Volume: (r x r) x (3.14) x (height)

The length of a stomach is 10-12" or 254 mm.

I have also read the sleeve surgery includes removal of 85% of the stomach.

I know there are a few assumptions and other factors, like how closely the surgeons sews, length of the stomach, maybe even how much elasticity an individual has (althought he stretchy part was removed), etc, but am I way off on my logic?

Just for kicks and giggles, here is the volume difference in the different sizes of bougies:

32 FR = 10.67 mm diameter = 22686 cubic mm

36 FR = 12.00 mm diameter = 28712 cubic mm + 27%

40 FR = 13.33 mm diameter = 35447 cubic mm + 56%

46 FR = 15.33 mm diameter = 46879 cubic mm + 107%

50 FR = 16.67 mm diameter = 55386 cubic mm + 144%

60 FR = 20.00 mm diameter = 79756 cubic mm + 252%

There is clearly a larger difference than meets the eye when looking at the instrument itself. The size of the bougie simply HAS to correlate to the amount of stomach volume remaining.

I found an intersting article on this from India here:

http://www.bmi-india.com/does-bougie-size-in-sleeve-gastrectomy-matter/comment-page-1/#comment-22904

Originally the standard was a 60 FR bougie size at this practice. They now recommend 34-38 FR.

Now, the next step would be assuming how much of a stomach on average is generally removed with a 32 FR bougie. If that number is 85%, then the next step would be:

32 FR - 15% remaining

36 FR - 19% remaining

40 FR - 23% remaining

46 FR - 31% remaining

50 FR - 37% remaining

60 FR - 52% remaining

I would also think, the larger you go, the greater the possibility of stretch later down the road as well as greater possibility of not removing the portion of the stomach that creates the hunger hormone grehlin.

Also in the article, the end result of stomach volume after a few years is similiar, so why not remove less if the results are close to the same in an irreversible procedure?

Another interesting article:

http://www.obesityhelp.com/member/carmelita/blog/tag/bougie+in+vsg/

"Optimal weight loss may require the smallest possible pouch, which may yield the highest leak rate"

That is certainly logical. Starving your body will result in weiht loss. To me, the journey does not need to happen in 4 months, 6 months to a year is fine, maybe even 2-3 years. Is the progress, long term prognosis, and overall quality of life that I am most interested in.

I would really like to hear from someone that used a size 40+ FR bougie AND that was lower BMI going into it. Is that too much to ask. LOL.

Sorry for going on. But, I would really like to hear some other opinions on this. I can also forward this to my surgeon to get his feedback. The more the better!

Hey guys

I read a study published by Dr. Cirangle that stated using a larger sized bougie (think it was a 40 or 44FR) resulted in the about the same amount of excess weight loss BUT resulted in less long term excess weight MAINTAINED than the smaller bougies. This is why he uses 32FR as a standard. I realy think the 32-36 FR will work better in keeping the weight off. The studies have proven it. This is why you find most doctors use a 32-36. I really think personally a 38 is fine. I'm not a doc though. You have to do what you feel is in your best interests.

how do they use this, do they shove it down your throat and then once in belly use that as a guide to cut around?