Patients often wonder how the bougie size affects their weight loss success with gastric sleeve surgery.

In bariatric surgeries like the vertical sleeve gastrectomy, your stomach is trimmed down to restrict food consumption and promote fast weight loss. The bariatric surgeon uses carefully crafted methods and medically innovative equipment to perform the gastric sleeve procedure.

One of the most important devices is the Bougie, pronounced “boo-gee.” The bougie size does affect the amount of weight you lose, complication rate, nutritional intake, and post-op success. At Mexico Bariatric Center®, our superior gastric sleeve surgeons perform minimally invasive procedures using dynamically fitting bougie that is reinforced with sutures.

What is a Bougie?

The bougie is a soft plastic tube that is measured in diameters used to calibrate the size of the new stomach for gastric sleeve or duodenal switch surgery.

This long silicone tube is endoscopically inserted through the patient’s mouth (down to the esophagus) to outline and form the new stomach. The surgeon uses the bougie to guide the cutter/stapler to take out a bigger portion of the stomach (about 80%) to give optimal results without looking into trouble.

The smaller the bougie size, the less chance of stretching the sleeve down the line. Removing the fundus part of the stomach is crucial as it is the stretchy part of the stomach and it carries the most ghrelin hormones.

Bougie Diagram in Stomach During Gastric Sleeve

How is the Bougie Measured?

Bougies are measured in units called French, abbreviated F, an equivalent of 0.333 mm or 1/3 mm. A 40 French bougie is equal to approximately ½ inch. In the United States as well as Mexico, the standard bougie size ranges from 27F-60F.

Expert weight loss surgeons in Mexico use smaller bougie sizes, typically between 32F and 36F, for the safety and effectiveness of each bariatric surgery.

Bougie Size Chart for Bariatric Surgery

There are multiple bougie gauges based on the patient’s needs and the surgeon’s intentions and priorities for the stomach pouch.

Gastric Sleeve Bougie Sizes

The Bougie is measured in French (Fr) which equals 1/3mm. The common range of a Bougie’s diameter is between 32Fr to 40Fr for the best outcomes and the least amount of difficulties. While MBC surgeons use a 34Fr Bougie with a .425″ diameter, it is based on the surgeon’s preferences and the patient’s goals.

Standard Bougie Sizes

  • 32Fr = .40″
  • 34Fr = .425″
  • 36Fr = .45″
  • 38Fr = .476″
  • 40Fr = .5″
  • 46Fr = .576″
  • 60Fr = .75″

The maximum tolerated stomach volume, or “gastric volume,” is determined strictly by the bougie measurement and the surgeon’s precision on cutting tightly along the bougie line.

Why is the Bougie Used?

The bougie serves two purposes;

  1. To measure how much of the stomach will be untouched by the sleeve and where the surgeons will be stapling the stomach. This makes it easier and safer for the surgeon to remove the excess stomach carefully and efficiently.
  2. Help diagnose and define what the end result will be for the patient.

This calibration is important as it directly impacts the amount of excess weight you lose. The closer the stapler gets to the bougie, the tighter is the sleeved stomach. The surgeon has to be experienced to make sure the pouch does not become too tight to create an obstruction.

One recent study sampled sleeve patients who had a 27F and 39F bougie size. The post-operative results had an insignificant impact on the volume of resected stomach, morbidity, and short-term weight loss. After one year patients with the smaller bougie size lost 5% more excess weight versus patients with a larger bougie (39 Fr).

Does Bougie Size Matter?

The Bougie measures how much of the stomach will be cut and stapled. If the Bougie is smaller, the patient will have less stomach capacity which will be easier to lose more weight. If the Bougie is bigger, the remaining sleeve-shaped stomach will be larger and a larger amount of food will be absorbed.

One study in Chile showed that within a year, patients calibrated with a 34FR bougie lost 20% more excess weight than patients with a 60FR bougie.

What Size is Right for me?

The same bougie size is not for everyone. The surgeon chooses the appropriate bougie based on the patient’s BMI, existing stomach size, age, and medical condition.

Surgeon’s skills and experience can affect the precision and safety of their work. A smaller bougie can make a gastric sleeve surgery riskier and cause nausea and other possible complications. The diameter may affect how long the patient has to recover.

In another study, the number of patients with a 32FR Bougie who had to go back to the emergency room was double the amount of patients with a 36FR Bougie. The 32FR group also had longer hospital stays than the other group.

The Bougie also helps reduce scarring, twisting, and tangling of the sleeve tissue which could lead to obstructive symptoms, including nausea and vomiting. If the bougie is too small and the surgeon is unable to accurately make their incision, this can cause tapered narrowing of the stomach, called sleeve stenosis. Obstruction or stenosis can develop months after the operation and make digestion too hard for the patient.

Why Get Gastric Sleeve?

If you haven’t had weight loss success with diets and exercise and suffering from type 2 diabetes, sleep apnea, or other health problems, Vertical Sleeve Gastrectomy (VSG), as a primary stand-alone procedure might be the best option for you. The stomach volume is reduced to limit the amount of food you can eat at each mealtime and get less hungry as the majority of the ghrelin hormones are taken out.

While there are multiple types of bariatric surgeries, such as gastric bypass surgery, adjustable gastric band or Lap Band, and duodenal switch, studies show that the gastric sleeve is one of the best types of weight-loss surgeries for people who want a minimally-invasive procedure and quick results.

Within a year, patients can expect to lose 65% to 70% of their excess weight. While gastric sleeve technical details (such as a bougie size) can be intimidating, the doctors will always be there to make sure you are comfortable and safe throughout this life-changing surgery.

Schedule a no-obligation consultation with our top surgeons at Mexico Bariatrics. Simply fill out our health questionnaire and we will contact you with your approval in less than 48 hours.

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