Is smaller the better?

@@bariatric_lady - I have heard pros and cons. Mine is a 36 which is the "norm" I was told.

I have heard of others who have 32s having really tough constriction and therefore have to really eat smaller amounts.

I have no idea what size bougie my surgeon used on me--I think to some extent it's dependent on your anatomy and your build and how big your stomach was to begin with. I would guess that they used a smaller one on me, a short-waisted 5'2" female, than they would on a guy who's 6'2" and built like a linebacker.

I'm a Bariatric surgery nurse and patient and a firmly believe a 32 is too tight. Many people end up with very bad reflux with this size.

My doctor uses a 36. When I spoke to him about it he said that smaller sizes have a higher chance of having complications occurring but no significant difference in weight loss.

When I saw the title of this topic, I thought the originator was being cute with a reference to men's shirt sleeve lengths. Obviously not. Then I saw "bougie."

Please give me a little info on what the numbers mean and what is a "bougie." I have a lapband, but probably will be revising to sleeve. Just a very little will help me know better what to research and formulate questions for my surgeon.

Thanks.

I'm a Bariatric surgery nurse and patient and a firmly believe a 32 is too tight. Many people end up with very bad reflux with this size.

I am sure there are increased risks with the smaller size, but it's what my surgeon uses and has worked very well for me

I also had a 32Fr bougie with the staple line oversewn to make it even tighter. Never had any issues and still no GERD at 2 years out. Love my teeny tummy.

BTW, here is a comparison of bougie sizes.....not much difference, really

I also had a 32Fr bougie with the staple line oversewn to make it even tighter. Never had any issues and still no GERD at 2 years out. Love my teeny tummy.

That's me exactly too!

I have a 34 size, but only know due to other posts on here and I got curious and asked. I don't have any issues with my stomach size. I honestly think he could have gone smaller as I seem to be able to hold more than half a cup of food when eating.

I don't think it really matters unless there are complications - some people will just get GERD or reflux or have issues no matter what size. I think it has little to do with the bougie size, and more about predisposition and dumb luck.

I am curious if having a smaller size causes further issues with getting the needed nutrition in (vitamins/nutrients - not just food). My surgeon mentioned removing 90% and I thought that sounded pretty high.

Here's a post I made a few months back:

Sleeve Gastrectomy – Does Size Matter?

by Kimberly Taylor on August 21, 2013 · Comments | Weight Loss Surgery


The gastric sleeve procedure has quickly become one of the most common types of weight loss surgery, jumping from obscurity to importance in only a few years.

Despite it’s newfound popularity among patients and surgeons, there are many technical aspects of the procedure including bougie size that remain controversial.

What is a Bougie?

The bougie (prounounced BOO-zhee) is a measuring tool in the form of a long, thin, flexible tube. The surgeon uses it as a guide when dividing the stomach.


During surgery, the bougie is put into the mouth and pushed down through the esophagus and stomach to the pylorus. The tube creates a bulge inside the stomach that the surgeon uses to guide the stapler when dividing the stomach. After the sleeve is formed, the bougie is removed from the body.

Bougies comes in a range of sizes that are identified by a unit of measurement called a French. 1 French is equal to 0.333mm (1/3 mm) and is abbreviated as F, Fr or FR. For reference, a 40F bougie measures about 1/2 inch (40F x 0.333mm = 13.32mm, converted to inches is 1/2″).

Standard bougie sizes in the United States range from 32-50F. The bougie size is not the same as stomach size, although it does influence the size of the sleeve.

Generally, the smaller the bougie, the smaller the new stomach size, but the same size bougie does not always create the same size stomach. The finished sleeve size is determined by how close the stapler gets to the guide and whether the surgeon oversews the staple line and if so, by how much.

While the gastric sleeve is now widely accepted as a primary bariatric procedure, there is not yet unanimous agreement on an ideal bougie size. The decision is trying to find the size that will provide the safest results with the most amount of weight loss.

With a smaller bougie size, the smaller the sleeve and greater the restriction, but greater the risk of leak and stricture rate.

A stricture is an excessively narrow section that develops when scar tissue grows and interferes with the normal movement of food and liquids into the stomach. It can cause upper abdominal pain after eating and chronic vomiting or regurgitation of undigested food. Symptoms usually start in the first 6 weeks after surgery. Strictures are very uncommon, but surgery is required to remedy the situation.

If a larger bougie size is used, the sleeve will be larger and the operation safer, but the concern is that it may not produce enough weight loss.

2008 Study

A study in 2008 found that a bougie size of 40F compared with 60F did not result in significantly greater weight loss in the short term.

Comparing 40F versus 60F:
At 6 months, the excess weight loss was 38.8% versus 40.6%.
At 12 months, the excess weight loss was 51.9% versus 45.4%.

(Study: Laparoscopic sleeve gastrectomy: does bougie size affect mean %EWL? Short-term outcomes. Surg Obes Relat Dis. 2008 Jul-Aug;4(4):528-33. doi: 10.1016/j.soard.2008.03.245.)

2013 Study

In a 2013 study, researchers wanted to find out if there is an ideal bougie size. To do this, they did a search of medical literature published in the last 5 years and analyzed 32 publications involving 4,999 patients.

What they found:
The use of bougies 40F and larger had a leak rate of 0.92% and excess weight loss of 69.2%.
The use of bougies smaller than 40F had a leak rate of 2.67% and excess weight loss of 60.7%.

The results show that larger sizing bougies had a lower incidence of leaks with no change in weight loss. The researchers call for further studies before a decision is made on optimal bougies size, but recommend caution in using the smallest bougie possible because the risks may outweigh the benefits.

(Study: The Effects of Bougie Caliber on Leaks and Excess Weight Loss Following Laparoscopic Sleeve Gastrectomy. Is There an Ideal Bougie Size? Obes Surg. 2013 Aug 3. [Epub ahead of print])

2012 Surgeon Survey

According to a 2012 survey of surgeons experienced in sleeve gastrectomy, the bougie size used ranged from 32F to 50F, with the most common size being 36F (used by 32% of surgeons surveyed). Studies show that the procedure is relatively safe, but there are still many variations in bougie size.

(Study: Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg. 2013 Aug 4. [Epub ahead of print])

Bougie Size

Bougie size is based on patient input, height, weight, and surgeon technique. The bougie size is typically smaller when the procedure is performed as a stand-alone procedure (32-50F) rather than part of the duodenal switch (50-60F).

Depending on the bougie size used by the surgeon, the new stomach size will be about 60-80% smaller after surgery. The average stomach holds 30-40 ounces, or roughly 4-6 cups per meal. After surgery, a small meal of 1/2 cup to 1-1/2 cups will fill the new stomach pouch. The sleeve will stretch somewhat from the surgery size, but will get no where near the size of the original stomach.

If you are planning to undergo the sleeve gastrectomy procedure, make sure you discuss the bougie size with your surgeon during the pre-op process. It is important that you understand the rationale for your surgeon’s recommendation and to feel comfortable with the size of your post-op stomach.

While bougie size is a consideration, healthy weight loss will ultimately depend on following a reduced-calorie, nutrient-rich diet. The sleeve will help reduce hunger and limit food intake, but it is up to you to choose the foods and liquids that you put into your body.



I made a quick EXCEL spreadsheet converting the size to mm and inches based upon the formula.
Note: Per this article, the surgeon's techniques contribute to the overall size ("...how close the stapler is to the guide...", "...whether they oversew"..., etc.)

Bougie Size mm Inches
32 10.66 0.42
33 10.99 0.43
34 11.32 0.45
35 11.66 0.46
36 11.99 0.47
37 12.32 0.49
38 12.65 0.50
39 12.99 0.51
40 13.32 0.52
41 13.65 0.54
42 13.99 0.55
43 14.32 0.56
44 14.65 0.58
45 14.99 0.59
46 15.32 0.60
47 15.65 0.62
48 15.98 0.63
49 16.32 0.64
50 16.65 0.66

Edited January 5, 201610 yr by 4MRB4PHOTO

Great information. Thanks for posting.

I also had a 32Fr bougie with the staple line oversewn to make it even tighter. Never had any issues and still no GERD at 2 years out. Love my teeny tummy.

I had the same surgeon and so far so good!