Bougie Size- Infamous Pen Photo-Question ???

This post is meant to create awareness, curiosity or just make you say........hmmmm?

The Pen photo may be the hands down the most reproduced photo here on the VSG forum. 

The infamous Pen Comparison Photo !!!! We've all seen it....... It is usually followed up by comments like...... Very Little Difference, Negligible, Teaspoons.

Even some Surgeons have been known to tell potential patients that sleeve size doesn't much matter....The sizes are negligible.....

If sleeve/bougie size doesn't make much difference and is a matter of teaspoons.......than all sleeves will eventually be only a matter of teaspoons apart in capacity....??????

Yes, surgical technique can differ and more or less trimming occurs in shape......

So why is there such a broad range in eventual capacity?

We see here on OH eventual capacity of 3oz. to 12+oz.

Is that negligible? Is that teaspoons apart ?

Just a question/observation.......

Disclaimer: There are successful sleevers with large bougies here on OH right now...... I recognize that a few people here with large sleeves have done well and part of my curiosity. 

frisco



   

Maybe it is in the length and not the width. That applies to other things too.....

I dunno width is good too.  LMAO

Oh you have really stepped in it this time.  Are you bored?  Because this will sure get things going this afternoon.  I actually love this topic because I am really interested in the differences between sleeve sizes, ( not just boughie used sizes, but the actual stomach size at maturation).  I have seen you and Jimbo eat, and I eat more than the two of you do.  I really think that Dr. Cirangle made your sleeve smaller or tighter than mine.  He might have had very good reasons to do this as I was a lightweight and you and Jimbo were heavyweights, but in truth, I wish he would have made mine a bit tighter too.  I really think that added restriction is a huge help in the long run and I can use all the help I can get.  On the other hand, I have seen other VSGers eat quite a bit more than I can.  I am talking about 3-4 times as much as I can eat.  I think they have a problem.  There are people that can and do succeed with any size stomach, there are even people that succeed without WLS or with a size 60F.  There are fewer of them, but it can be done.  Of course it all comes down to what we put in our mouths, but that is true for us even before surgery, I know that I personally need a powerful tool to help me stay where I am. 

I think the big misconception here is about the fact that all VSG surgeries help you lose weight in the first six months or so, it is much later, when the sleeve has matured and stretched, that any issues in capacity really show up and can cause issues.  I think people who are just a few months out, post that they are doing just fine, and of course they would be, the stomach has not yet healed and stretched.  OK, here we go, bring it on, this should be a lively read in a few hours.  I might even have to unblock those who I have blocked in the past just to get at the full drama here.  Fire the engines and ready for takeoff. 

  I'm right there with you waiting for the impending discussion...

 
Well....yah...kinda bored....my plans for today went with the bad weather.....locked up inside doing work instead.....thinking I should have gone to the LA meet-up in Santa Monica......

So.... no better time to start a fire !!!!

Bring it on !!!!

I can take it !!!!

frisco

**As proven in my past..... I want everybody who takes on such a drastic medical and lifestyle change to get the most out of it......

Hi Elina-
I just had a consult with my surgeon, Dr. Morris Washington, last Tuesday. And thanks to one of your earlier post, I had a list full of questions. As far as boughie size, he said that he uses a 40. I was a bit concerned because one of your suggestions earlier was to have a tight sleeve. I questioned him and he said many surgeons use the 32 but do not staple close to it as much as 2 inches from it. That made sense to me and was confirmed after I, too, watched a procedure. He said I should be able to hold 2-3 oz.

I agree, the end capacity is what counts here not a particular boughie size.  I just want you to consider asking him, for your, OK mine, peace of mind, does he mean 2-3 ounces after the sleeve has healed and matured?  I can tell you that I can eat a great deal more than that now and my doctor is known for making some of the smallest sleeves in the industry.  I do believe that surgical technique has a great deal to do with the capacity achieved in the end.  I know a few people who swear to me that they had a 32F but they can eat a great deal more food than I can.  Please know that I only mean this to be helpful.  Have you asked him about how many sleeves he has done in the past few years?  Also, what is his expected success rate, in other words, how much EW does he expect you to lose?  You don't have to answer me, I just want to make sure you know the answer and are comfortable with it.  I don't know your surgeon and have no preconceived notion at all, just want to do due diligence and be in your corner. 

I didn't ask him about whether or not the 2/3oz was after healing, but I definitely will.  He has completed over 300 sleeves at the time of my consultation, but has done hundreds of other WLS.  I asked him how many patients experienced leakage and he stated patient #80 did, but that they recovered fine and doing well.  He also stated that recently one of his patients 4 months out had already lost 80#, but didn't give me a % lost. 

I welcome your advice and comments.  Iron sharpens iron.

 Fighting the urge to comment about both length and girth mattering...

I watched a video of Dr Alvarez showing the bougie in use - while it was definitely a guide, he wasn't stapling right next to the tube - there was definitely space between the bougie and his tools.

I would guess that between natural human variation in length, how close the doc staples (and if she oversews) and where the stretchier part of the fundus starts we'd find differences between people who had the same size bougie. 

Plus, let's not forget our geometry - the difference between a 32 & a 40 isn't much in diameter, but it adds up when calculating geometry!

(pizza math - the difference in area between a 11" & a 12" pizza is 18 square inches or about 20%. However the increase in diameter is only 9%)