About VSG

Sleeve Gastrectomy is a surgical weight loss tool in which the stomach is reduced to about 25% of its original size, by surgical removal of a large portion of the stomach, following the major curve. The open edges are then attached together (often with surgical staples, glue and possibly cauterization) to form a sleeve or tube with a banana shape. The procedure permanently reduces the size of the stomach and is performed laparoscopically and is not reversible.


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Monday, January 30, 2012

bougie size

Credit for this to Carmelita at Obesity Help

The word bougie means "candle" in French.  "F or Fr" following a bougie size=French

Its just a guide that the surgeon uses to butt the stapler up against, when forming your VSG. The closer s/he gets to the guide the 'tighter' /truer to guide the sleeve is. During surgery the bougie is inserted into your mouth down your throat, towards the end of yer stomach where it meets the pylorus via an esophagheal dilator. After the new stomach is formed, the bougie/guide is removed out of your mouth, why some VSGrs may complain of a sore throat post op.

Some surgeons will use an endoscope or other "guide" to size ones new stomach. I read an OH post of a VSGr who's surgeon explained an endoscope is the same size as a 32F bougie...Im not sure.

Bougie size determination is between YOU and YOUR surgeon. Discuss size, rationale, type bougie and technique used when sizing your stomach PRE-OP.   Some surgeons may "oversew" the staple line giving one a 'tighter' than bougie sized sleeve.
Added:  In order for an OVERSEWN staple line to affect stomach size it MUST be running or continuous oversewn line across majority of staple line not merely at intersected "junctures" where the surgeon has reloaded the staple gun as majority of "oversewn" (to prevent leaks) techniques are done today. Make sure your surgeon explains  what his/her "oversewn" technique is. Do not assume because a surgeon oversews you have a tighter than bougie sized sleeve.

A bougie is 1/3 mm PER french.  i.e to calculate ~ inches 40F bougie  1/3 x 40 = 13.33mm convert to inches = ~.52 inches or ~1/2 inch in diameter.

Below are diameters of bougie/ "guides" in inches

32F = .40"

34F = .425"

36F = .45"

38F = .476"

40F = .5"

46F = .576"

60F = .75"

This VSG surgery video shows  a 'red' 34F bougie, one technique in sizing stomach, exised stomach, testing for leaks etc
.http://www.orlive.com/shawneemission/videos/weight-loss-surg ery-gastric-sleeve
Red bougies are older commonly used mercury filled ones. FDA is tryin to ban em because of disposal issues (mercury).


Some surgeons will use SINGLE USE disposable sized bougies
In this surgical video Dr. Alvarez shows a disposable 32F bougie and use/technique
         ( pic below of a 32F bougie inserted in an esophageal dilator)

      General/ crude comparison chart created by MACK a VSG Forum member

Standard sized bougies in the US and Mexico are 32F. Your surgeon may prefer any size bougie from 32-50F, based on YOU, your height, weight, or perhaps the need for a malabsorptive procedure in the future, inc. 1st step of 2 part DS. Discuss what to expect, rationale for size chosen with your surgeon if this is a concern.

LapSF/Dr. Criangle on their routine use of 32F bougies in VSG  "Optimal weight loss may require the smallest possible pouch, which may yield the highest leak rate" .
Some surgeons will welcome requests on bougie size changes. For example..My surgeon will use standard 32F bougies depending on individual. After reading a published journal on the higher incidence of VSG surgically induced GERD acid reflux/heartburn when using 28-32F bougies, I instead, requested a 34F bougie. My surgeon obliged me. Post op I never needed or took a perscribed or OTC PPI. Coincidence? more than likely!

 In ~2000  use of 40-60F bougies were standard for VSG when it became a stand alone WLS, as they were the standard sizes of DS bougies, which VSG was modeled after. As the years went by, bariatric surgeons thought..smaller bougie, better restriction, less regain. So in ~2005 an adopted 32F bougie became the VSG standard. Rarely, are 28-30F or over 50F bougies used in the US anymore. Many Many VSGrs do EXTREMELY well with 40F and up bougies as the guide to sizing the new stomach.

An ~2009 study on BOUGIE SIZES in VSG  seems to indicate at 5 years post VSG ... 44F and 32F bougies show EXACTLY the SAME  EWL (eventual weight loss)
An ~ 2008 study comparison of 40F and 60F bougies with no difference in EWL at 6 months or 12 months post op. http://www.soard.org/article/S1550-7289(08)00358-4/abstract

PRE VSG: Average stomach holds 32-48 oz or 4 to 6 cups per meal
POST VSG (6 months out FOR LIFE) ..new stomach holds 8-12 ozs or 1 to 1.5 cups per meal
                                    (depending on density of foods you eat!)

The COTTAGE CHEESE TEST may be helpful to VSGrs that are curious about their new stomachs capacity. when doing this test PLEASE eat to sensation of satiety NOT full, and absolutely not overfull. It was developed for RNY but an effective tool in VSG as well!

The length of an adult stomach is 10-12 inches. DNA affects the length of our stomachs, as well as variations in shape. Tall people, for instance are known to have LONGER stomachs..so makes sense they have a bit more capacity. Volume/capacity is essentially a question of the LENGTH and PHYSICAL ANATOMICAL VARIATIONS of your stomach. Restriction makes no difference however.

Dr. Alvarez explains in this You Tube video about length of an individual's VSG stomach and how it relates
to volume. http://www.youtube.com/watch?v=-5E7G0Avz4w&feature=share

This limited 2009 study is interesting in looking at gastric capacity in VSG,
just 3 days post op (120 ml=~1/2 cup) compared to 2 years post VSG (250 ml=~1 cup)

At the end (8:28 mark) of this LapSF VSG surgical video shows 1 DAY old (pod) sleeve Xray and a sleeve Xray at 4 years out. It is not clear to me if same pt. or solely to impress the new "normal" sleeve size. Note the "new normal" 32F tightly formed sleeve has dilated/stretched naturally to triple perhaps quadruple in size...The video also shows one technique of sizing the sleeve, as well as reinforcement of the staple line (to prevent leaks) http://www.youtube.com/watch?v=rRBKdTjY2Rg

This VSG video shows the speed with which LIQUIDS/FLUIDS empty from the sleeve. In normal stomachs fluid empty rate is less than 5 minutes. In VSG stomachs: looks MUCH faster than that! you decide. http://www.youtube.com/watch?v=K0GWL1Wtx30

STRETCHING in VSG:YOU CANNOT STRETCH/DILATE out your sleeve to anything remotely close to its original size.

From LapSF/Dr. Criangle: The removed section of the stomach is actually the portion that stretches the most. The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food.
The fundus is ALL but removed with VSG. The fundus is the upper most part of the stomach's greater curvature. The fundus is:
1) the stomach's stretchy/expandable tissue, capable of expanding 2-3xs its resting 'unfilled' size
2) the pre-op 'mass quantities' of food, waiting to be digested, storage section
3) where 70% of the body's grehlin " the hunger hormone" is produced.

Stretching, due to overeating is most common in RNY because more of the stretchy fundus part of the stomach is retained to make the 'pouch', and is usually NOT covered by insurance to correct.  Re-sleeving or a need for a malabsorptive surgery post VSG may or may NOT be covered by your insurance plan.

Anecdotally, with continual overeating to discomfort, one might "stretch" your sleeve minimally. Ive read nothing to date that says this is a TRUE statement.

Just post op VSG ...because of swelling/inflammation even a little 'thick/er' dense liquids/mushies feels horribly restrictive. In a few months..that swelling/inflammation is greatly reduced and your on a regular diet. Depending on the food, you can eat more or less at any particular meal. Its quality over quantity. Toleration of a food, does NOT make it a good choice!

The bougie size controversy/wars are ridiculous imo.. 'get a smaller one, you can stretch it out, you're not going to have any restriction, that big one is all wrong, you'll re-gain easily years out, mine's smaller and I got to goal 2 months post VSG'
...all nonsense  DO NOT PAY EM NO MIND!!  This is YOUR story! YOUR journey! 

                                         ALWAYS REMEMBER THIS TRUTH: 

              Most important is the quality and quantity of the food choices you ingest post-op 


     from this...........to this         
                                                and ROCK THAT SLEEVE :-)


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