Percentage of removed stomach in Gastric sleeve?!

[mmy 62]

Hello I was wondering if anyone has any medical documentation on the percentage of gastric sleeve (i.e. How much of the stomach to be removed) I have mixed information about this as some say it's one size or percentage and some say anywhere between 80-90% and some say anywhere between 50-90%.. My surgeon recommends 55% gastric sleeve for me because of my low BMI but I couldn't find any research or documentation about a similar case.

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[Micoxv 276]

I guess it really depends from the surgeon and the case. Mine told me he removed 85% of my stomach, not because of my BMI but because He has a standard sleeve size that he applies to his patients. After about 900 sleeves done, I believe he knows what he is doing [emoji4]. Then the percentage will depend on how dilated is your stomach prior to surgery. Mine obviously was way oversized. Hope it helps.

[4MRB4PHOTO 3,899]

Depending upon the surgeon, the bougie size used the patient's BMI, etc., from what I read, it is typically in the 75-85% range of stomach removal for someone with a very high BMI.

[VSGAnn2014 12,992]

The deal about % of stomach removed is that if the surgeon doesn't remove all the fundus (the stretchy part of the stomach where ghrelin, the hunger hormone, is produced) you won't get the reduced hunger benefits of VSG surgery.

My understanding is that the fundus is around 85% of an intact human stomach.

You should do some more research about WLS -- to understand what it is and how it works.

Best!

[mmy 62]

The deal about % of stomach removed is that if the surgeon doesn't remove all the fundus (the stretchy part of the stomach where ghrelin, the hunger hormone, is produced) you won't get the reduced hunger benefits of VSG surgery.

My understanding is that the fundus is around 85% of an intact human stomach.

You should do some more research about WLS -- to understand what it is and how it works.

Best!

As I said there is no documentation about %. I couldn't find anything. 2 doctors said I would benefit from a modified Bariatric surgery with one of them insisting on 55%. The 3rd doctor I spoke to today said that the percentage differs from one patient to another depending on the size of the patients stomach. There is one size for the tube inserted through the mouth but what might account for 80% in one patient might be only 50% in another patient.. I am still waiting for a reply from my surgeon regarding that but I don't see harm in trying to ask here and gather as much information as I can.

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[4MRB4PHOTO 3,899]

There are a range of sizes for the bougie, ex 32F, 40F The diameter is in mm and each French (F) is 1/3mm.

I posted an article here a while ago with a chart I made showing the size and equivalent diameters.

The article also brings up important points as how tight the surgeon staples the line to the bougie, etc. can affect the sleeve size.

[mmy 62]

There are a range of sizes for the bougie, ex 32F, 40F The diameter is in mm and each French (F) is 1/3mm.

I posted an article here a while ago with a chart I made showing the size and equivalent diameters.

The article also brings up important points as how tight the surgeon staples the line to the bougie, etc. can affect the sleeve size.

Hi can you please post the link to your article!

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[Mburk72 13]

I thought the amount that was removed was the same for everyone, something I need to ask my surgeon before my procedure.

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[Micoxv 276]

I understand the concern, but does that really matter? I mean at the end you will end up with a tube that fills up very fast and that is the idea. I did not see my stomach before and I don't see it now. I am getting used to the quantity I can eat (still not easy to easy to put the right quantity on the plate).

[mmy 62]

I understand the concern, but does that really matter? I mean at the end you will end up with a tube that fills up very fast and that is the idea. I did not see my stomach before and I don't see it now. I am getting used to the quantity I can eat (still not easy to easy to put the right quantity on the plate).

Actually it is important. Because I have heard of people having a failed gastric sleeve because the doctor did not remove enough of the stomach. I am a self paid patient and need to make sure that what I am doing is the right decision . I can not afford neither financially nor risking my health and go through the gastric sleeve again. Not many doctors or options are available near where I live. In fact I have to travel to the nearest country that offers the surgery with reputable doctors. And that's what I did for my first consultation

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[Micoxv 276]

I am also self paid and this is once I did all of the pre op tests that my surgeon told me how much he would removed. He also had the reputation to do tight bougies to avoid failures. I am not saying it is not important but you should rather focus on the surgeon experience and may be talk to some of his patients ? I did that and it helped me. Good luck with your search.

[mmy 62]

I am also self paid and this is once I did all of the pre op tests that my surgeon told me how much he would removed. He also had the reputation to do tight bougies to avoid failures. I am not saying it is not important but you should rather focus on the surgeon experience and may be talk to some of his patients ? I did that and it helped me. Good luck with your search.

The surgeon I went to is considered to be one of the top in the region. He has done hundreds of surgeries. The patients I talked to were all from the higher BMI group and I couldn't find anyone with a low BMI and similar situation. No one has done a 55% gastric sleeve.. That's why I'm here in this forum now to try and see if anyone has been through a similar surgery or has some information about this .

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[4MRB4PHOTO 3,899]

@@mmy, here is the post I was referring to:

The following is some info I found re: bougies.
It is not the ultimate source, I would prefer JAMA articles over this, but it's something to refer to.

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

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.

[mmy 62]

@@mmy, here is the post I was referring to:

The following is some info I found re: bougies.

It is not the ultimate source, I would prefer JAMA articles over this, but it's something to refer to.

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

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.

Thank you so much dear. That was a help. Sorry for the late reply I'm new to this forum and especially to this application.. Appreciate it. I have found another good surgeon in a country nearby and will go for a normal 80-85% sleeve.

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[ZillyNa 16]

Hello. I'm waiting for sleeve surgery too. In my case I understood that the doctor intends to cut 70-75 % of my stomach, so it will contain just a volume of 150 ml maximum circa. Doing a research for a query similar to this topic, I found that the surgeon decides the amount of percentage to cut basing the evaluation on many factors. There isn't an only size for the result, that is decided depending on the patient conditions. The same surgery is made also for very different health problems of the stomach, for example to eliminate mutating stomach metaplasia. In this case the surgery criteria are the opposite of the aim of weight loss, so they try to preserve the maximum portion of stomach and give to the patient a post op diet studied to gain or keep weight...

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Edited May 12, 2016 by ZillyNa