Stupid Question Alert! Why Remove 80% Of Stomach, Why Not 65%

[DanaInNewOrleans 513]

I'm sure there is a good reason that 80% - 90% of the stomach is removed but would it be possible to decide ok, maybe this person would do better long term with only 60-70% removed? It just seems like there would still be great results without be sooo restrictive for a lifetime. Anyone know if this is possible? Can you ask that more stomach be left?

Thanks!

Dana

[Darkkyss 33]

I found a site, but my computer died !! but it has to do with a certain size, they found if to small, or to big it just does not work...they stick this tube down your throat and into your stomach and they staple along that if you go to youtube there is surgeries on there you can watch even. It really made me feel better seeing what they are going to do to you.

[Liberated Sleeve 148]

I believe my surgeon told me they remove the portion that is stretchy - and if they left part of that well then you could stretch your stomach back out by over eating again>???

[Darkkyss 33]

I found this not the same site but good info

:What is a Bougie, and what size do you use?

A bougie is a soft flexible rubber tube that comes in multiple sizes. They are designed to stretch esophageal strictures. We use them to calibrate the size of the gastric sleeve. The size indicates the circumference in millimeters. I use a Size 32 bougie, which translates to a diameter of about 10 millimeters or 0.4 inches. This is very thin, and explains why you can't eat very much! It is placed temporarily while performing the operation, then removed."

http://laparoscopy.com/pleatman/vsgfaq.htm

[RickM 1,747]

There is some ongoing discussion within the bariatric community as to what stomach size is optimum - too small and there seems to be more problems with reflux and too large is thought to lead to more regain longer term. This is an area where they are waiting for more 5+ year studies to provide guidance. Our bodies do adapt in time and we can consume more as time progresses and we move to a more varied diet

Generally, they will talk in terms of the starting size of the sleeved stomach because the % removed is a large variable due to the variability of stomach starting sizes (so that 85% figure that we hear so often is an average or generalization.) My stomach started at about 2.5 oz at surgery (RNY pouches tend to be around 1 oz) while a larger stomach of maybe 4 oz is commonly used with the DS in concert with its malabsorption. At about 15 months out, I have little problem getting in 1800-2000 calories per day with a well balanced healthy diet and that is maintaining my weight well (I've been at goal for most of this year.) Many who are smaller at goal (and women, who typically have a somewhat lower % of lean body mass than men,) need less to be stable, while others who are more active than I need somewhat more and are able to accommodate those needs. DSers, with their malabsorption, often need around 3000 calories per day to be stable and get in the nutrition that they need - a level that would have the vast majority of us VSGers back at our original weight in short order.

As to the reason they settled on the sizes that they use now, I suspect that since the stand alone VSG evolved from the DS and has no malabsorption component to help it along, they felt that a somewhat smaller sleeve than they typically use in the DS would work better for most getting the VSG by itself.

[joyful noise 101]

I would like any size that removes the ghrenlin hormone. But, the smaller the better for me. Easier to fill and be full.

[DanaInNewOrleans 513]

There is some ongoing discussion within the bariatric community as to what stomach size is optimum - too small and there seems to be more problems with reflux and too large is thought to lead to more regain longer term. This is an area where they are waiting for more 5+ year studies to provide guidance. Our bodies do adapt in time and we can consume more as time progresses and we move to a more varied diet

Generally, they will talk in terms of the starting size of the sleeved stomach because the % removed is a large variable due to the variability of stomach starting sizes (so that 85% figure that we hear so often is an average or generalization.) My stomach started at about 2.5 oz at surgery (RNY pouches tend to be around 1 oz) while a larger stomach of maybe 4 oz is commonly used with the DS in concert with its malabsorption. At about 15 months out, I have little problem getting in 1800-2000 calories per day with a well balanced healthy diet and that is maintaining my weight well (I've been at goal for most of this year.) Many who are smaller at goal (and women, who typically have a somewhat lower % of lean body mass than men,) need less to be stable, while others who are more active than I need somewhat more and are able to accommodate those needs. DSers, with their malabsorption, often need around 3000 calories per day to be stable and get in the nutrition that they need - a level that would have the vast majority of us VSGers back at our original weight in short order.

As to the reason they settled on the sizes that they use now, I suspect that since the stand alone VSG evolved from the DS and has no malabsorption component to help it along, they felt that a somewhat smaller sleeve than they typically use in the DS would work better for most getting the VSG by itself.

Thanks so much for all the info everyone. If I was given a choice I think I would choose to have a little more stomach left. One of my concerns is that I will never be able to enjoy a meal with my husband or have Christmas/Thanksgiving dinner like everyone else. Of course I know that everything is a trade off. But again, having 30% instead 15% of my stomach just seems more "sane" and more reasonable for a lifetime of restriction.

[DanaInNewOrleans 513]

Do you guys know if there are any docs that answer questions on this forum? I really want to ask if it would be possible for me to say to my surgeon, hey I'd like to leave 30-35% of my stomach.

Can he make a subjective empirical decision or is this an absolute "follow the pack" surgery?

[DanaInNewOrleans 513]

Do you guys know if there are any docs that answer questions on this forum? I really want to ask if it would be possible for me to say to my surgeon, hey I'd like to leave 30-35% of my stomach.

Can he make a subjective empirical decision or is this an absolute "follow the pack" surgery?

I forgot to mention that my gut ( no pun intended!) tells me that having 30% of my stomach is healthier than 10% and still gives me the significant restriction.

[iggychic 1,405]

You missed the answer....they take out the stretchy portion which not only is super stretchy (weather you have 10% stretchy or 30%) and leave the muscle and non gremlin (my favorite word lol) producing area. If you have more left you won't be successful because the stretchy portion won't restrict.

That said, a year or so out you will be able to enjoy just about everything you want but hopefully will have learned to get your basics in. Xmas dinner can be throughly enjoyed....just not three plate fulls with a side of pie (which I saw someone do this Xmas and was astounded when they started complaining about being unable to lose weight....while eating an entire pie!).

I digress . this isn't a cattle car surgery. Current studies suggest the route that is taken now is a good one. If (as with all medical technology) things change, well then they will change. Is this something you want to wait for?

[Carrie's Journey 130]

Do you guys know if there are any docs that answer questions on this forum? I really want to ask if it would be possible for me to say to my surgeon' date=' hey I'd like to leave 30-35% of my stomach.

Can he make a subjective empirical decision or is this an absolute "follow the pack" surgery?[/quote']

I asked my dr that. He is one of the best out there...a pioneer of the vsg (Dr Cirangle). He said he could do that, but he wouldn't. He always uses a 32 bougie. I was just curious so I didn't push it, but he said success rates would be way down. He has been doing the vsg for a very long time.

Personally I wouldn't mind not over stuffing my face during the holidays again. I hated how I felt after. I'm just looking forward to having a little bit of everything and not letting hunger control me.

[O.T.R. sleever 3,386]

I was told that once fully healed my stomach capacity will be 8-10oz. Now say we double that size, an I have a stomach that is 16-20oz.

That's a pound of food or more. I can pack a lot of calories into a pound of food. Plus with that kind of volume I probably wouldn't watch my diet nearly as well.

I mean, heck I've got plenty of room why not order that Bloomin' Onion we can share it, I'll just have the Victoria's filet instead of the Melbourne & I'll share a chocolate Thunder from Down Under.

Wait, no way I just ate over 1200calories!!!! That's 1/2 what I use to eat, and I didn't drink anything.

That damn surgeon left too much stomach. I think I'm gonna sue him for malpractice. Everybody knows that the sleeve is not supposed to be this big.

[DanaInNewOrleans 513]

You missed the answer....they take out the stretchy portion which not only is super stretchy (weather you have 10% stretchy or 30%) and leave the muscle and non gremlin (my favorite word lol) producing area. If you have more left you won't be successful because the stretchy portion won't restrict.

That said, a year or so out you will be able to enjoy just about everything you want but hopefully will have learned to get your basics in. Xmas dinner can be throughly enjoyed....just not three plate fulls with a side of pie (which I saw someone do this Xmas and was astounded when they started complaining about being unable to lose weight....while eating an entire pie!).

I digress . this isn't a cattle car surgery. Current studies suggest the route that is taken now is a good one. If (as with all medical technology) things change, well then they will change. Is this something you want to wait for?

No, you're right. I don't want to wait. Life is series of trade offs and this is just another one with a huge up side! I think what I'm also worried about is how labored everything seems to be after the surgery....eating/not eating enough protein/don't drink this or that/drink enough water/eat this but not that.....although some people seem to have a bigger commotion than others. Mostly I just hope to forget about food-- eat when I need to. I keep hearing about "mushy" foods-- ick! I'm hoping to be able to eat mostly everything just in much much smaller portions. Is this realistic?

[DanaInNewOrleans 513]

I was told that once fully healed my stomach capacity will be 8-10oz. Now say we double that size, an I have a stomach that is 16-20oz.

That's a pound of food or more. I can pack a lot of calories into a pound of food. Plus with that kind of volume I probably wouldn't watch my diet nearly as well.

I mean, heck I've got plenty of room why not order that Bloomin' Onion we can share it, I'll just have the Victoria's filet instead of the Melbourne & I'll share a chocolate Thunder from Down Under.

Wait, no way I just ate over 1200calories!!!! That's 1/2 what I use to eat, and I didn't drink anything.

That damn surgeon left too much stomach. I think I'm gonna sue him for malpractice. Everybody knows that the sleeve is not supposed to be this big.

LOL... Yeah, I guess 20oz can do a lot damage. 20oz of Haagen Dazs or a Bloomin Onion would be a disaster! Ok, I get it. 15% is better than 35%....

[SunnyCox 245]

I think what I'm also worried about is how labored everything seems to be after the surgery....eating/not eating enough protein/don't drink this or that/drink enough water/eat this but not that.....although some people seem to have a bigger commotion than others. Mostly I just hope to forget about food-- eat when I need to. I keep hearing about "mushy" foods-- ick! I'm hoping to be able to eat mostly everything just in much much smaller portions. Is this realistic?

This is what happens with the normal sized sleeve. No matter size you end up with, you are going to have issues in the first 1-2 months. You had major trauma to your stomach. It is swollen and needs to heal.

I had surgery 6/28. I am not even two months out, and I can pretty much eat anything I want in small portion. I do make an effort to get more Protein and less carbs. I keep my calories low and my Fluid intake high. These were things that I knew I should do before surgery, but I couldn't stick to it. After surgery, it is so much easier. The sleeve makes me more accountable for my actions, and for that, I'm grateful. If I get off track one day, it is so much easier to get back on track the next day instead of blowing it all together. You'll still be able to have plenty of dinners with your husband and family, but you'll probably never be the person who cleans her plate, plus an appetizer, plus a dessert. You'll eat a few bites of the appetizer, a portion of your dinner, and a few bites of dessert. I can't tell you the last time my SO and I were able to share a dessert and be satisfied until now. We are saving a ton of money dining out, and we both walk away from the table fully satisfied.

The day before my surgery, my SO asked the surgery why he had to reduce my stomach so drastically. He actually asked if they could remove half maybe three quarters. Dr. Kelly told him that they found that people were not as successful with larger sized stomachs that stretched out again. Now that I am a bit removed from surgery, my SO thinks the sleeve is a great choice for me. A lot of his fears about me being unable to eat properly have subsided. The hardest part is the first month when you are healing and adjusting.

As far as mushy foods, it isn't as gross as you would think. I simply went to cream Soups, thinly sliced deli meats and cheeses, eggs, chicken salad, finely ground hamburger meat, really thick shakes, or added Protein powder to more normal foods. Every diet is different.