Sleeve Size?

[Rjc0704]

I'm reading a little about differnet sleeve sizes. My BMI is 30 and I would like to lose 45-50 lbs. Who decides what size sleeve? Do patients have any say in it? How do I learn more about it? I am interested in learning what would be ideal for me. I am a little concerned that they will make my sleeve too big and there won't be enough restriction or as much weight loss as I hope to achieve. I am learning that it is possible to loose a little too much, but that it is possible to eat high calorie foods to help with that.

[Ann2]

Some docs use the same size bougie to form all their patients' sleeves. I've heard (on this board) that Alamanza uses a 32 bougie for all. My surgeon says he uses a 36 for all, unless there's some significant reason not to do so.

And then there are some surgeons who give big men slightly larger sleeves (40 bougie) than they give to smaller women (32-34 bougie).

But the size of bougie is only one aspect of a sleeve's *size*. Some surgeons stitch or double-stitch (or, for all I know, triple-stitch) along the staple line they make beside the bougie-shaped new tummy. All that stitching reputedly tightens up the tummy and guards against not only leaks but future stretchage.

There's much debate (and a LOT of misunderstanding) about post-op stomach stretchage in years post-op. Some people 3-4 years out feel lots of restriction. Others don't and think they can eat as much as they did pre-op at a single sitting.

It's definitely true that if you want to retain tummy restriction long-term that you must always eat protein first. Protein fills up your stomach and does not pass quickly into the intestine. That's why you feel restriction after eating protein first. But if you first eat slider foods (google that term) you can eat a lot more, especially if you eat leisurely enough. Also, grazing all day instead of eating at mealtimes will increase your intake. Also, drinking your calories (sweet tea, alcoholic drinks, sodas, etc.) will lead to regain, too, since our smaller stomachs don't restrict at all the amount of liquids that we drink.

When they say your new sleeve is "only a tool" and that your eating behavior and discipline is what's most important to your long-term success, they ain't kidding.

Finally, I recently read some research about short- and long-term weight loss results for VSG patients whose surgeons used bougie sizes ranging from size 30 or 32 to size 40. Bottom line -- there weren't any significant differences.

Having said all the above, you SHOULD talk to your surgeon about your bougie and explore all the questions / thoughts / concerns you have about bougie sizes and her/his surgical techniques. You will surely learn a lot more than I've typed here. If you find out more or learn that anything in this comment is wrong, please post it here. Thanks.

[Batmanswifeislosing]

I totally agree with Ann2, talk to your surgeon and Kudos to you Ann for such an informative post. I really have nothing to add to that.

[missemily516]

I have tried a few times to question my surgeon about bougie size, he has never responded with specific information (he either changes the subject or gives me a generic answer), so I stopped worrying about it. I don't know what size my stomach is, but it is small stomach and I feel the restriction. I feel very successful after a year and 120 lbs lost.