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As some may know, I have been trying for WLS since August of 2005. Finally my time came and I was sleeved. I was a very active member on ObesityHelp until I found this site. Enjoy the info and videos...
 
The word bougie means "candle" in French. "F or FR/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 esophageal dilator. After the new stomach is formed, the bougie/guide is removed out of your mouth, possibly why some VSGrs 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 for size chosen, type bougie and technique used when sizing your new stomach........ PRE-OP!!
 
Some surgeons may "oversew" the staple line giving one a 'tighter' than bougie sized sleeve.
In order for an "oversewn" staple line to affect stomach size it MUST be running or continuous oversewn suture line across majority of staple line not intermittent oversewn nor merely at intersected "junctures" where the surgeon has reloaded the staple gun as majority of "oversewn" techniques (to prevent leaks) 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"
 
 
Video 1
 
This VSG surgery video shows a 'red' 34F bougie, one technique in sizing stomach, exised stomach, testing for leaks etc
.http://www.orlive.co...eight-loss-surg ery-gastric-sleeve
Red bougies are older mercury filled ones. FDA is tryin to ban em because of disposal issues (mercury).
 
 
More surgeons will use SINGLE USE disposable sized bougies
 
Video 2
 
In this surgical video Dr. Alvarez shows a disposable 32F bougie and use/technique
 
 
~9-2012
In another Forum, this member's bougie pix is from hospital she works at 1st: 36F, 2nd: 38F on left, 32F on right

 
 
General/ crude comparison chart created by another Forum member


 
 
Standard sized bougies in the US and Mexico are 32F. 32F is the smallest guide a bariatric surgeon in the US may safely use in forming your sleeve. 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 discussion and your input on bougie sizes. After reading a published journal on the higher incidence of VSG surgically induced GERD (acid reflux/heartburn) in use of 28-32F bougies, it may be wise to request a higher bougie size. However, like all surgeries, we will need years of data to support whether or not this claim is actually true.
 
The History of using Bougies
 
In 2000 the use of 50-60F 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, if ever are 28-30F or 50F and over bougies used in the US for VSG as stand alone anymore. Many many VSGrs do EXTREMELY well with 40F-48F bougies as the guide to sizing their new stomach, losing all the weight they need to.
 
In 2008 study (small poll 135 pts) on Bougie Sizes in VSG seems to indicate at 6 mos and 12 mos post VSG .... 40F and 60F bougies with no significant difference in EWL (eventual weight loss) 2008 Bougie Size Comparison
 
In 2009 study (a large poll) on Bougie Sizes in VSG seems to indicate at 5 years post VSG ... 32F and 44F bougies show exactly the same EWL (eventual weight loss) 2009 Bougie Size Comparison
 
In 2012/13 study (a very large poll) on Bougie Sizes in VSG seems to indicate at 3 years post VSG, a LESS than 40F bougie and GREATER than 40F bougie show no difference whatsoever in EWL (excess weight loss) 2012/13 Bougie Size Comparisons
 
 
VOLUME/GASTRIC CAPACITY in VSG:
 
PRE VSG: Average stomach holds 32-48 oz or 4 to 6 cups per meal
POST VSG (~6-8 months out FOR LIFE) ..new stomach holds 8-12 ozs or 1 to 1.5 cups per meal
(depending on weight/density of foods you eat! can be much less or much more)
 
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, short people have shorter stomachs therefore less capacity.... so volume/capacity can be influenced by the length and physical anatomical variations of an individual's stomach.
 
Dr. Alvarez explains in this You Tube video about length of an individual's VSG stomach and how it relates
to volume.
 
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)
http://www.ncbi.nlm.nih.gov/pubmed/19533260
 
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 perhaps triple in size...The video also shows one technique of sizing the sleeve, as well as reinforcement of the staple line (to prevent leaks)
 
This VSG video shows the speed with which LIQUIDS/FLUIDS empty from the sleeve. In normal stomachs fluid empty rate is 5 minutes or less due to space creating a reservoir for large volumes of fluids. In VSG stomachs: fluid empty rate looks MUCH faster than that... youdecide!
 
The COTTAGE CHEESE TEST /CCT (link following) may be helpful to VSGrs that are curious about their new stomachs capacity. It was developed for RNY but an effective tool in VSG as well! I'd suggest waiting until you are on a regular diet before checking. When doing this test PLEASE eat to sensation of satiety - no longer hungry, and absolutely not full.
 
A simpler method, following the basic guidelines and time frame in the link provided... is to place 1 level cup (8oz) of small curd cottage cheese in a bowl and eat from that. Using a measured tablespoon to eat any remaining cottage cheese from the original container. Add or subtract any cottage cheese eaten or not finished using the measured tablespoon. 2 TBS=1oz. Total...the amount consumed = your sleeve's capacity.
http://www.bsciresourcecenter.com/proddetail.php?prod=A4
 
 
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 (inc. majority of stomachs 'body' up to pyloric canal) of the stomach 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 a "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, Ive read from select OH VSG members, or according to a/their particular surgeon..overeating will cause your sleeve to stretch out. Ive read/found no scientific data, published or otherwise, to date that says this is a TRUE statement.
 
Since food stays in our stomach less than ~ 3 hours after a meal..common sense tells me food doesn't stay in our stomachs long enough to create 'stretching'. Food once ingested, immediately begins to be churned into a liquidy sludge called chyme through peristalsis in the stomach. This liquidy sludge must be small enough to pass through our very small pyloric valve and into the small intestine for further digestion /breakdown and absorption of 'micronutritents' ...so there cannot be enough pressure for long sustained periods of time in our stomachs to cause it to stretch.
 
 
Post op VSG ... depending upon the amount of swelling/inflammation you have..even a little 'thick/er' dense liquids or pureed foods/mushies may or may not feel restrictive, as you pass through the progression of texture dietary phases ( to promote healing) and onto your regular diet ~2mos post op. ... swelling/inflammation has naturally reduced. Density of meals becomes a key player in restriction. By 1 year out you'll find you can eat more than you could at 2 days post op, at 2 weeks post op, 2 months post op, and 6 months post op. Your sleeve has naturally and fully matured.
Depending on the food..you can eat more or less than the 8-12 oz capacity of a fully matured sleeve.......at any particular meal.
 
Toleration of a food, does NOT make it a good choice!
"just because I CAN...doesn't mean I DO"
 
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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 bigger one is all wrong, you'll re-gain easily years out, my surgeon made mine smaller and I got to goal in 6 months'
...all nonsense DO NOT PAY EM NO MIND!! This is YOUR story! YOUR journey!
 
 
ALWAYS REMEMBER THIS TRUTH:
 
YOUR WEIGHT HAS NOTHING TO DO WITH THE SIZE OF YOUR STOMACH, altered or not!
 
Most important is the quantity and quality of the food choices you ingest post-op

They say the journey of a thousand miles begins with 1 step. What they don't tell you is that the journey is a b*tch if you're on step 1!
 
1/14/2015
Well it's been a few months since I last walked. November to be exact. With the cold weather and injuries and sinus drainage, I was pretty much out of commission. We were at it hard during September and October, hitting new highs on speed, sometimes going as fast as 3.9 mph for 3 miles.
 
But November, my partner hurt his ankle and was out for 3 weeks, then I got terrible sinus headaches from breathing the smoke from neighbors burning piles of leaves and then the cold rain set in. So here it is, the middle of January and we haven't walked a mile per day. Fortunately, I've actually lost weight in that time and kept it off. My new job keeps me moving quite a bit.
 
8/26/2014
Wish there was more the report, but it's still HOT in Texas. Most days the temp is around 91 with a heat index of 101 when I walk. I've had to start wearing a water soaked towel around my neck and a hat while I walk to complete 3 miles. I've come close to heat exhaustion a few times and had to head over to the water faucet and soak my head till the dizziness clears. I thought I'd have built up a tolerance to the heat by now, but doesn't seem like that is going to happen. Good news is, the worst of the heat is over, once we hit September temps will slooooooowly creep down to the low 90's every evening. And by October, we'll be back in the 80's. I can't wait to see how fast I can do 4 miles when the temps are down in the 80's. Hopefully, I'll break the 15 minute mile. :-)
 
7/30/2014
I know I keep saying this, but OMG!!! IT'S HOT IN TEXAS! The good news is that today was a cloudy day and I managed 4.25 miles @ 3.6 mph. I should be up and above 4 mph by the time cool weather rolls in during October.
 
The heat is still in the 94 - 95 degree range with a heat index of 101 - 104. And as Madge said on the Palmolive dish-washing detergent, "You're soaking in it." :-P I'm still walking 5 days a week and hugging every inch of shade I can find! But I had to cut back to 3 miles, down from 4. I was just getting too dizzy and sick - even with using a water soaked towel to keep cool and carrying a water bottle. Monday, I had to stop at 2.5 miles and go soak my head under a water faucet. I hit a point and knew I had better get cooled off or something bad was about to happen.
 


 
7/24/2014
OMG!!! IT'S HOT IN TEXAS!
For the past week it's been between 91 and 94 degrees with a heat index of 101 - 104... during the evenings... when I'm walking! I've had to begin carrying a wet towel and carry a water bottle to prevent dehydration and heat exhaustion. But aside from that, I've managed to walk between 3 and 4 miles in about an hour, averaging 3.5 - 3.7 mph. And haven't missed a day this week. But you gotta believe it when I say I was looking for ANY excuse to skip walking after work. But alas, the weather has been clear during the evenings and all the rain has managed to miss my exercise hour. I wonder how much it would cost me to have a crop duster fly up and seed some clouds just around the time I supposed to start walking????
 
7/04/2014
Another 3 miles (including 1 mile in total of jogging in short stretches) in the record book. It still amazes me when I think back to just 18 months ago when I would go to bed wondering how much it would hurt to walk from the car to my desk at work.
 
The Texas heat is a monster and I was really dreading walking (I mean baking) in 94 degree heat with a heat index of 101. That was yesterday! But I got rained out at the last minute. :-) ****Does happy dance**** I know, I know, I should be like those workout gurus and tell you how much I missed not going out there and sweating my ass off. But I gotta be honest and say I will take any "HONEST" excuse to duck out on walking in this heat. When I say "HONEST EXCUSE" I mean just that.... a real, "believable", reason (rain, when my car had a flat 2 weeks ago, or I feel like I've been pushing myself to the point of injury or sickness). Skipping a walk just because I don't feel like it is not enough.
 
So this morning the I had planned to walk with a friend at Claiborne Park just north of Vidor, TX. We normally do 3.25 miles and I've been increasing the distance I've been jogging. But the radar shows rain headed right for us in the next hour or so. So we cancelled it.
 
Instead I ran around my neighborhood. One lap around my block is approx. 1/2 mile. 2 long sides and 2 short sides. In 70 degree weather, I managed to run 12 of the short sides for a total of 1 miles....And the amazing part was I could have done more! So we'll see how much more tomorrow when I'm back out at Claiborne.

 
 
6/29/2014
Can't believe how well my attempts to jog are working out. Averaged 3.5 mph for 3.25 miles today. I walk a figure 8 style track and managed to jog the 4 straightaways all three laps. My next goal is to jog 1 mile non-stop. Shooting to reach that goal by the end of July. If the heat gets to be too much for me, my fall back plan is to go back to wearing the 30 lb weight vest and speed walk the trails.
 
6/19/2014
Another 3.25 miles down. Speed is still slow at 3.1 mph. Temp 91 degrees. Managed to make the whole circuit on 13 swallows of water. It's a pain to have to carry a water bottle on the trail, but it beats getting heat stroke!
 
It's been tough getting used to the Texas heat. The heat's really been kicked up a notch since the end of May. I thought it was bad when the temps were in the high 80's. Oh how I long for those days. My walking partner calls me the shade hunter. He's much more tolerant of the heat. He can walk in full sun for the whole 3.25 miles, while I zigzag on the trail - going from one patch of shade to the next. I think I may actually be walking farther than him, but he carries the GPS, so I have to go by his distance and time. Doesn't matter to me though, just completing the whole trail every day is a win.
 
06/18/2014
Man is it hot! The Texas Summer heat is just getting its stride and things are baking in the park. I'm up to 3.25 miles each day/ 3.1 mph while wearing a 30 lb vest. Fastest speed without the vest was 3.6 mph for 3.25 miles. Thinking it might be time to try the couch to 5k plan. Not really sure all this effort is worth the results. It's a vicious cycle - the more I get in shape the farther/faster I have to walk to burn the same amount of calories.
 
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10/02/2013
Hit a new personal best time at the park. 3.2 miles an hour, did 3 point something miles in about 53 minutes or something close to that, I've forgotten the exact time. :-) But at least I'm getting better, both in distance and being able to recover enough to walk at the same intensity day after day. It seems like only yesterday (actually it was Jan 2nd) that I started my walking program by taking the long way around the office to the bathroom. :-P Just goes to show that taking small steps can add up to bigger things later on.
 
7/11/2013
Well, I lost Gilligan, my pedometer. I named him Gilligan cause he was my "little buddy". Not sure where he ran off to. I left the house with him on my hip and at the end of the day, he was gone.

 
So now I have Gilligan the 2nd or Gilligan the Next Generation, depending on your point of view. Gilligan II is a little smarter, so hopefully he won't get lost. He keeps track not only of my steps and mileage, but takes into account my weight, lists calories burned, total steps, aerobic steps (meaning any walking continuously for 10 minutes or more) and tells me how long I've been aerobically walking . And he remembers everything from the past 6 days.

 
The good news is that I've graduated to a 2 mile trail in a local park. It has lots of ups and downs - and the occasional rabbit/armadillo/snake/Pimp butterfly on the trail to keep things entertaining. And I'm able to make the walk 6 to 7 days a week.
 
My 1st goal was to be able to complete the 2 miles every day 6 to 7 days a week. I have reached that goal as of July.
 
The next goal is to start increasing my speed. See if I can break the 45 minute mark for completing the trail. Current best speed is 46 minutes.
 
 
5/17/2013
Finally! Made over 10k steps a day for 6 days in a row. My original goal was to do it for 5 days in a row. Plus as an added NSV, I have graduated from walking on flat, level surfaces to walking in a parking garage. I do the 1st 5k steps in the morning on level ground, but at lunch, I step it up (no pun intended) by going out to a 3 story parking garage. Having to walk up those inclines between floors add a whole new level to the phrase "pain in the butt!" :-P
 
I was walking next to a coworker yesterday and she said, "I smell smoke." I said, "That's me. I'm not just hot, I'm SMOKIN!"
 
For those out there that have feet and knee pain like me, it pays to move, no matter how little. That's how I started out 5 months ago.
 
I could barely walk from the parking lot to the store without limping and being in a lot of pain. But I always parked at the far end of the lot and minced my way into the store. And I set a goal to walk the inside perimeter of my office every time I went to the bathroom or had to leave my desk. That was 4 to 10 laps a day.
 
When we move to a bigger office in Feb. I set a goal to make 4 laps a day around the office (approximately 1200 steps plus the 500 steps from the parking lot to my desk got me up to about 1700 steps a day).
 
When I got to the point where I could tolerate the 4 laps with no lasting pain, I added 4 laps at lunch. Then 5 in the morning and 5 at lunch till I could do 10 each time. That took several months to accomplish and I usually only could do that at most 3 days a week and be in pain for the other 2 days.
 
Now 10 laps twice a day is too easy, so I changed to going into the parking garage at lunch. The inclined ramps are easy on my ankles and ups my aerobic activity. Plus it gets me out in the sun - gotta have my Vitamin D!
 
That's how I did it. Little changes add up. Now I've got 2 ladies a work who SAY they want to start walking with me - but so far it's only been talk. :-)
 

This is from today, 5/17/2013. It's gonna break my heart to reset it in the morning!
 
 
2/19/2013
Just checked my pedometer when I got home and finally crossed the 10k steps goal or 4.5 miles in 1 day.
 
I usually on get in around 2.5 to 3 miles a day, but today I had a lot of extra walking at work and for the 2nd day this week I've been able to walk additional laps around the building at lunch.
 
Hopefully my feet and hips will allow me to maintain or surpass 10k a day from now on.
 
Update:3/28/2013
Still managing to get closer to my goal of 5 miles/day, 7 days a week. I'm averaging 4.5 miles/day 4 days a week. My hips no longer hurt, just some muscle soreness. And my feet are usually only a little painful after walking but the pain is almost gone the next day.
 
The people at work are starting to take notice of my walking before work and at lunch time. Commenting on my weight loss, that may sound encouraging, but I'd rather stay unnoticed and unremarked on. Noticing my weight loss and exercising will only lead to questions - ones I'd rather not answer.
 
I've had one or two people comment on how much they need to start walking with me, almost daily, but they never seem to find the time to do even one lap around the floor with me. I never made those type of comments when I'd see people working out, cause I knew that I wasn't going to make the effort. So why try to fool them and me? If I did, it would feel like I was apologizing for being fat and feeling guilty for not exercising.
 
I didn't feel like any kind of exercise plan was going to do me any good. I was too far gone. As Ralphie May said, "This is way past a diet coke fix."
 
 
3/4/2013
I'm still walking 3 - 4 miles per day, 5 days a week, but getting past 10k steps a day is tough. My feet and hips are pretty sore the day after doing that many steps and it limits me reaching 10k more than 2 or 3 times a week. But I keep working at it. As long as I'm walking every day, I'm getting closer to my goal.

Just a few notes on some of the changes I've noticed in myself over the last 9 weeks post-op.
 
1. I eat when I'm hungry now, don't really look forward to the "full" feeling or have a "taste" for anything in particular anymore - lovin' it. I use to get these overwhelming cravings for a certain taste (especially Whataburgers), they're gone now.
 
2. I do enjoy what I eat and sometimes I still catch myself trying to eat just one more bite, but I know I'll be feeling sick if I do. It takes time to learn the new "full" signals.
 
3. I feel satisfied and I get a small thrill seeing how little I actually eat now. Although sometimes, I catch myself trying to finish that last bite - even though I'm full. I've learned to leave it on the plate.
 
4. Once my staple line swelling went down, I was able to increase my eating to about 4oz per meal, and did start feeling more "normal" after the 2nd week, but it wasn't until about week 6 that I was back at my old energy levels.
 
5. I can eat pretty much what I want and walk away without gorging myself. I have always been able to take or leave stuff like cakes and cookies. Rice, pasta and potatoes were (I almost wrote "are") my thing. But I can easily pass up most starches now. Although pasta triggers my hunger cravings and I have to stop myself from overeating and making myself sick.
 
6. My feelings or attitudes has changed incredibly about food. Don't really care about food anymore. I have no "flavors" I desire. So I eat my own concoction of shredded grilled chicken, re-fried beans, cheese and salsa almost every meal - for the past month.
 
7. There isn't anything that I "want" to eat anymore. I am so happy with my restriction and I don't miss anything, no food cravings, nothing I miss. And there is no food that I couldn't eat at the 3rd or 4th week. It may cause some stomach upset, but if I eat it slowly, I can eat it if I want. However, I do miss being able to chug 16oz of icy cold Crystal Light.
 
8. I can still eat spicy foods (curries, peppers, etc). I eat salsa almost daily and I found this sweet/spicy dip made with Greek yogurt that I like - very warm. I find it weird that the thing that bothers my stomach the most is healthy fibrous foods, like grape skins, bananas, apple peels, and pineapple.