Bougie Size and recent results, questions

[LOWCALGAL 6]

Preparing for my sleeve on march 25th and for sure I am looking into long term result. Two recent studies seem to indicate that:

A- Bigger bougie size (above 40 up tp 60) does not reduce weight loss at 3 years but it reduces leaks and GERD (acid reflux)

http://www.ncbi.nlm....pubmed/23023201[/font][/font]

b- Long term side effects reported after 5 years include GERD and regain[/font][/font]

h ttp://www.ncbi.nlm.nih.gov/pubmed/20622654[/font][/font]

In light of this I am wondering what the best middle ground might be. I am discussing this with my doctor but would like to hear more about real people with actual life experience. Has anyone here had a large bougie size guide of 40 and up ?

am wanting to ask my doctor to use a bougie 50 or 48 in light of this does anyone have information about that ?[/font][/font]

2-One question I have is about working out - when can I start again ?

[DrmBig4Evr 152]

The Bougie sizes more commonly used now are 32, 34 and 38 French. You are reading a study published in 2008 as this is the only data with long term results. As a result of these findings doctors use a smaller bougie now. I was sleeved with a 32 French and I was up and walking that evening. I have walked daily since surgery. I have been using small weights for my arms. I cannot lift anything more than 15 lbs in 15 days and I will be cleared at one month to go back to regular full exercising.

[LOWCALGAL 6]

In the most recent study (2012) they showed no weight loss change from a bougie 32 or 48. But more side effects from the smallest (gerd and leak) that is the first link.

Thanks for the kind words and kuddos to you !

[DrmBig4Evr 152]

I'm sorry I went on google, I didn't see the links til I came back. Here is another one I found about bougie that might help you...

http://www.bmi-india.com/does-bougie-size-in-sleeve-gastrectomy-matter/

[LOWCALGAL 6]

Thanks for the link, an interesting read for sure. Here is the info I was looking at:

Abstract

OBJECTIVE:

To conduct a systematic review to identify surgical strategies that

may decrease leak after laparoscopic sleeve gastrectomy (LSG).

BACKGROUND:

LSG is growing in popularity as a primary bariatric procedure.

Technical aspects of LSG including bougie size remain controversial.

METHODS:

Our systematic review yielded 112 studies encompassing 9991 LSG

patients. A general estimating equation (GEE) model was used to

calculate the odds ratio (OR) for leak based on bougie size, distance

from the pylorus, and use of buttressing on the staple line. Baseline

characteristics, including age and body mass index (BMI), were

included. A linear repeated measures regression model compared excess

weight loss (%EWL) between bougie sizes.

RESULTS:

A total of 198 leaks in 8922 patients (2.2%) were identified. The GEE

model revealed that the risk of leak decreased with bougie ≥40 Fr (OR

= 0.53, 95% CI = [0.37-0.77]; P = 0.0009). Buttressing did not impact

leak. There was no difference in %EWL between bougie <40 Fr and bougie

≥40 Fr up to 36 months (mean: 70.1% EWL; P = 0.273). Distance from the

pylorus did not affect leak or %EWL.

CONCLUSIONS:

Utilizing bougie ≥40 Fr may decrease leak without impacting %EWL up to

3 years. Distance from the pylorus does not impact leak or weight

loss. Buttressing does not seem to impact leak; however, if surgeons

desire to buttress, bioabsorbable material is the most common type

used. Longer-term studies are needed to definitively determine the

effect of bougie size on weight loss after LSG.

It states that above 40 is safer and doe not affect weight loss...also the scientist named in both studies is my doctor - so it's annoying as it makes discussion difficult hahaha !

[ShrinkyDinkMe22 376]

This is my take on the whole thing. The bougie size is strictly a tool to help guide the doctors in stapling your stomach.

In the end the size difference bt a 32f and a 40f is very minimal.

What also needs to be taken into consideration (imo) is a Dr can use a 40f and staple right snug up against the bougie or he can use a 32f and staple a few millimeters away. In essence still creating a larger than 32f stomach. Meaning that depending on the Dr techniques the bougie size really do want matter when your talking 32-40. I haven't read any drs using larger than a 40f.

Then there is also the length of a stomach. From the research I've done everyone's stomachs are different lengths. So someone with a shorter stomach and using a 32f will hold less volume than a longer 32f stomach. Something to keep in mind.

Here's a few links I found along the way.

http://www.verticalsleevetalk.com/topic/40624-bougie-size-and-amount-of-weight-to-lose-is-there-a-relationship/

http://m.obesityhelp.com/member/carmelita/blog/2011/03/31/-2/

Not sure if this helps but that's my take on the subject.

I was sleeved on 12/10 with a 40f and so far all is great!

Good luck to you.

Also I'm learning why slider foods are called sliders. If you don't follow the diet and do not eat Protein first you will be able to eat a lot more than you think.

[LOWCALGAL 6]

Thanks for your information on sleeve size.

For sure any given surgeon has a style, but none can really cut too close to the guide, as there is a rather standard distance range that they are adhere to in the profession. It is clear that stomach lenght is part of the equation, I hope only to not be too small as I want to be sure to avoid Gastric Reflux and leakage.

Thanks again!

[DrmBig4Evr 152]

Here is my two cents on the reflux, I already had it big time and didn't realize it. I thought it was hunger. My doc found a rather large hiatal hernia and I had a feeling something was wrong for a few years. My doc said that his patients who already had reflux didn't have any issues with reflux post surgery.