Sleeve Percentage Difference!

[Zyad 7]

Hello everyone

my doctor told me that he removed 70-75% of my stomach. How different is that from the people who removed 80% or 85%? Does 70-75% makes it easier for me to eat normally faster than the others?

thanks

[AJ Tylo 1,399]

I wish i had done in the 70's I think it just gives you more capacity but not sure

[Zyad 7]

That’s what I’m hoping to listen

[Likklelime 12]

I'm tuning in as this topic interests me. I am supposed to have the sleeve but am hung up on this issue. I wish they could only remove 50% the 75-80 seems so high.

[thisgirlsherry 17]

Hi! My surgeon was pretty standard across the board and sticks with removing about 80%. But I did research this topic a bit prior to surgery and the basics of what I learned was that some surgeons will remove less than that based on how much excess weight a person has to lose (ie if they don't a ton of excess weight they may not want to give as much restriction). Another reason to remove less is for quality of life purposes. Before I had surgery that didn't make a whole lot of sense to me - how is less removal going to help me? But now that I am 10 months post op I get it. I'll never enjoy a normal sized meal again. It does take some getting used to. Emotionally, eating becomes much less satisfying. It's something you definitely have to come to terms with.

I am not a doctor, but I would say yes, you probably will be able to eat more than others eventually.

I wasn't given an option on how much of my stomach was removed. I was basically given the run down of the procedure and the percentages were determined by the surgeon. If I was given a choice, I would still choose to have 80% removed. After a few months, you start to be able to eat more. I've been able to eat enough now to stop the weight loss process. If I had even more stomach, I fear that I could regain if I wasn't careful.

At the end of the day the old adage still stands - it's just a tool. Use it right and you will have success regardless!

[Zyad 7]

The reason why I wanted to know is that they gave everyone (bypass, sleeve...) the same diet to follow. I want to follow a specific diet for my own situation. Knowing more about the percentage will lower my anxiety when trying to eat something new or drink more liquids.

[thisgirlsherry 17]

Have you asked your surgeon why they took a smaller percentage? I'd be curious to know.

The first few weeks after surgery, while you're healing, everyone has the same diet because eating solid food right away is too much. The liquid, soft, pureed, etc. stages help you heal. The size of your stomach shouldn't matter much...you need to follow the plan and make healthy choices, portion sizes, in order to lose the excess weight.

Eventually, you may be able to eat more than some, but that doesn't mean you should. I wouldn't worry too much - it's not a huge percentage less than others. Your stomach will do a good job of telling you how much it can handle

[Zyad 7]

I should ask him. You’re right. I didn’t do the surgery to eat/drink more ✌🏻.

thanks for the info.

[Uomograsso 364]

My doctor didn't go into percentages. He said my new stomach would be the size of a small banana. Each surgeon has their own preferences.

[catwoman7 11,212]

I suppose it partially depends on the size of your original stomach, too. Some people may have bigger stomachs pre-surgery than others.

[Starwarsandcupcakes 2,053]

My surgeon never said to me how much was removed. My nutritionist once mentioned something about a 32 Bougie (the tool they insert into the stomach as a guide before stapling it to it’s new size). From my understanding most sleeves are done between 30 and 40 Bougie (.4” to .5”). In a study with porcine stomachs the smaller the Bougie the greater the stretch when inflated. It was a small study so not sure if results are consistent with it in human conditions.

[PollyEster 228]

There are many factors that dictate what our final stomach capacity ends up being. The first is bougie size. A 36Fr bougie with 75% stomach removal will give us a lot more restriction than, for example, a 50Fr bougie with 85% stomach removal. The tightness of the staple line against the bougie, and whether or not the surgeon oversews the staple line will further decrease the diameter of your sleeve. My surgeon uses a 40Fr on all of his patients, but staples extremely tightly along the bougie, meaning his patients should have greater restriction -- and fewer complications -- than those who have, say, a 34Fr with no oversewing. At 3.5 months for example, I still cannot eat more than 2.4 to 2.8oz per meal, and it takes at least 75 minutes to comfortably eat it. Those who had strictures requiring removal during surgery would likely have marginally more restriction. Scar tissue and gastric motility also play a role in restriction. More critical than any of these, however, are our eating habits, since they play the most significant and influential role in sleeve capacity, amount of weight loss, and long-term maintenance.

Edited February 12, 2020 by PollyEster

[Likklelime 12]

2 hours ago, PollyEster said:

There are many factors that dictate what our final stomach capacity ends up being. The first is bougie size. A 36Fr bougie with 75% stomach removal will give us a lot more restriction than, for example, a 50Fr bougie with 85% stomach removal. The tightness of the staple line against the bougie, and whether or not the surgeon oversews the staple line will further decrease the diameter of your sleeve. My surgeon uses a 40Fr on all of his patients, but staples extremely tightly along the bougie, meaning his patients should have greater restriction -- and fewer complications -- than those who have, say, a 34Fr with no oversewing. At 3.5 months for example, I still cannot eat more than 2.4 to 2.8oz per meal, and it takes at least 75 minutes to comfortably eat it. Those who had strictures requiring removal during surgery would likely have marginally more restriction. Scar tissue and gastric motility also play a role in restriction. More critical than any of these, however, are our eating habits, since they play the most significant and influential role in sleeve capacity, amount of weight loss, and long-term maintenance.

Wow! This is so informative. Thanks so much for this information @pollyesther

[PollyEster 228]

1 hour ago, Likklelime said:

Wow! This is so informative. Thanks so much for this information @pollyesther

In both North America and Europe, removal of anywhere from 70% to 85% of the stomach is standard, so when you study VSG statistics, be assured that the percentage of stomach removed is not a factor in determining successful outcomes. There’s also increasing evidence that VSG induces weight loss through other physiological alterations, not just restriction, including increased intraluminal stomach pressure, which causes early satiety; increased gastric emptying for faster small-bowel transit time; and neurohormonal changes, including the reduction of both fasting and meal-stimulated ghrelin production and increased glucagon-like peptide-1 and peptide-YY, an intestinal hormone that increases satiety.

The most recent study I read that assessed the stomach volumes and pressures of several hundred patients in the US who had undergone VSG, where the standard bougie size for VSG is 32Fr to 50Fr, found that sleeve volumes held anywhere from 90 to 220 ml. Normal stomach volume is approximately 1,500 ml for both adult men and women; there is actually very little variation there. When the sleeves were filled with a volume of saline, the pressure inside the sleeve rose to 43 mm Hg compared with 34 mm Hg when the stomach was intact, meaning that VSG reduces the stomach’s ability to distend, thereby increasing the amount of pressure within the intraluminal space. This increase in pressure is what leads to the feeling of fullness, and allows us to drastically reduce caloric intake.

It’s quite some time after surgery before we are able to eat with anything resembling speed, and part of our pre- and post-surgery routine should be building a vigilant mindfulness practice to train ourselves to eat slowly until doing so becomes a deeply ingrained neural behavior. Once you've entered maintenance (if not well before), you'll be grateful for the small volume and the restriction as it's essential for keeping the weight off long-term.