4MRB4PHOTO

What a great NSV and morale booster. Keep up the excellent work.

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.

Congratulations on this milestone and your fantastic effort!

Could he be scared that something could happen to you during the surgery or maybe insecure that you may want to leave him for another man after you lose the excess weight? Speak to him and find out why, the open dialogue will help both of you express your concerns. He is probably still supportive, maybe at that little moment in the heat of an argument, his mouth was running at 8,000RPM but his brain wasn't in gear. My wife was never very supportive, she might say a few things on Facebook, but I go by people's actions and words expressed to me.

I am glad everything worked out ok. Just think of the additional small wait as time to do a little more preparing for the VSG and the new you.

From my recollection, it took from my counting down from 100 to 98 then waking up in the recovery room. The surgery should take 1-2 hours depending upon the complexity and experience of the surgeon. If you have any additional work needed (hernia repaired, removal of the gallbladder (if they find it diseased), etc.) it will take a little longer.

Yes, only one major one, not having this life changing surgery a few years ago. Congratulations on your upcoming surgery.

That sounds so naughty! Maybe if it involves whipped cream? If so, choose the fat free kind.

(From LipstickLady's post) I can eat more now than I could at one day out. I can't eat more now than I could at 9 months out. And I drink Coke Zero. THROUGH A STRAW!! OMG, COKE ZERO WITH A STRAW!!!!!!!!!!!! CAFFEINE!!!! CARBONATION!!!! A STRAW WHERE YOU CAN SUCK IN AIR!!!!!!!! Oooh, I'm feeling weak just thinking about that. To quote Fred Sanford (Redd Foxx character): (Saying this as I clench my chest) "Elizabeth, I'm coming to meet ya', this is the big one." Naaaah, just kidding. I'll enjoy one too.

For ever. Long term use is not recommended due to ulcers. Short term use is acceptable if there are no other choices.

I had the VSG. There seems to be two rules of thought regarding this procedure and the stretching of the sleeve. 1. You can only stretch it very little by overeating (within reason). 2. This can stretch this quite a bit by overeating, carbonated beverages etc. I read many posts and articles supporting both schools of thought. I spoke with my surgeon's nurse regarding carbonated beverages and the stretching of the remaining stomach for a VSG patient. She backed up my feelings, if the carbonation was that strong to stretch your stomach, the carbonated gas pressure would exit the stomach (as in a burp). The remaining stomach could stretch a little, but it won't stretch that much (if someone is gorging themselves to the point of discomfort, I am sure there would be a little more stretching). My surgeon warned me the "honeymoon period" following the surgery will end after about 6 months. At this point, I will be able to eat more than earlier into the post surgery eating. He was right. I wonder if some people are grazing all day, eating more food than they should, not eating slow enough (~20-30 minutes) to listen to their body cues that they are full (I am guilty as charged of that), not measuring or weighing their portions, eating too much high caloric foods, excessive slider foods, exercising less, not drinking enough Water or drinking during or right after a meal, not eating enough Protein, (or combinations of these) and feel it is due to stretching -especially in the case of "slider foods", such as high calorie sweets and refined white flour, where we can eat more of these?

You jump on a pogo stick and you no longer strike oil.

Getting the VSG procedure I have no regrets, my life has been positive since. Not getting sleeved a few years back, then yes.

Congratulations on your surgery. Everyone needs to be their own health advocate. We need to read up as much as we can and ask questions or research the answers when we don't know. Search topics here for some first hand experience and on the internet (from reputable sources such as major hospitals, JAMA, etc.) for studies from professionals in the weight loss surgery, nutrition & medical fields. Your body is going not only through physical changes (including hormonal) but you are going through mental changes too. Be happy for what you are becoming and don't look at what you can't do, it is far out shadowed by what you can and will be able to do now. As far as not eating the foods you ate before, that is not entirely true. You should be able to eat the same foods as you did before, just that you need to eat them in moderation and some of them less frequently and in moderation (like "slider foods"). You are on the path to a new you. It is a weight loss journey, you will gain wisdom and learn along this path.

Hmmm, Can I give into temptation that the post Easter tool sale at Sears is calling me?

The easy way out is to do nothing and continue to be obese, have comorbidities from it and live a lower quality life up to an earlier death. The weight loss surgery requires a lifetime commitment to eating a little differently and exercise. There are small risks involved with the surgery and after (but the long term health risks of obesity are far worse). You owe no one an explanation of having the surgery and you are being honest if you say you are on a doctor's supervised diet, are eating less, making healthier food choices and exercising more. Just leave out the surgery part if you want.

I am very happy for you. You are an inspiration to many.

I'm sorry for your loss. I bet he is looking down right now and smiling with pride for you.

A few days shy of my 50th birthday.

I have a great idea, instead of watching this show for (1 hour?, I don't know, I don't watch it), we should exercise in our own homes, the gym or walk that additional (hour?) each week.

Lol. I hope you meant "Your pants unintentionally fall to the ground in public".

Your talking scale no longer says "Only one person at a time, please!".

I was taking Metformin (1000mg 2x's/day) up to 2 weeks before my surgery last year. I had type-2 diabetes (for 2 years). Since the surgery and my weight loss/exercise, I have not had to take any medicine for my blood glucose, my pre/post glucose meal readings have been normal as have my A1C readings (the last three were in the upper 4's, the highest reading I ever had was in the low 6's). My endocrinologist told me that I no longer have to see him. I will continue to check my glucose readings but on a less regular basis. I can't promise that this will happen for you (hopefully it will), but at the very least you should see a dramatic change in your glucose levels as you lose weight and exercise more.

Doesn't sound like you were "McLoving It". Your body is no longer being subjected to as many additives and reacted as such. It makes you wonder what we are really putting in our bodies.

I started off at a pants size of 50/52 and now wear a size 40/42. My shirt size went from 3XL to XL. I can buy clothes at any clothing store now and now can wear pants with a designer label over one back pocket if I choose (I don't, designer labels aren't important to me) instead of labels that say "Pass" and "Don't Pass" over the back pockets. .