Gastric Sleeve Surgery: What’s Your Bougie Size?

The gastric sleeve procedure has become very common in terms of weight loss surgery.  In spite of its recent popularity among patients and surgeons it’s still controversial, especially regarding bougie size.


What is a Bougie?

 The bougie (BOO-zhee) is a measuring device in the form of a long, flexible tube. Surgeons use it to guide them when dividing the stomach.

During the surgery the bougie is inserted through the mouth and guided through the esophagus and stomach to the pylorus.  The tube creates a bulge that the surgeon uses to guide the stapler in dividing the stomach.  After the sleeve is formed the bougie is removed.

Bougies come in various sizes and the unit of measurement is called a French, abbreviated F.  1F = 0.333 mm or 1/3 mm.  A 40F bougie is equal to ½ inch for example. Standard bougie sizes in the U.S. range from 32 – 50F.

Generally, the smaller the bougie used, the smaller the new stomach size.  But the same size bougie doesn’t always create the same size stomach.  A lot depends on the surgeon and whether he/she over sews the staple line, and if so by how much.

There is no unanimous agreement on the ideal bougie size for a given patient.  This is a challenge because each procedure requires the surgeon to find the size that will be the safest, yet allow for the most amount of weight loss.

The smaller the bougie that is used, the smaller the sleeve and the resulting stomach restriction.  But there is a greater risk of leakage and instances of stricture.  A stricture occurs when scar tissue develops and interferes with the normal movement of food and liquids into the stomach.  It can only be corrected with surgery.

On the other hand, if a larger bougie is used, there is less risk but then maybe less weight loss as well.

Gastric Sleeve Surgery


2008 Gastric Sleeve Bougie Study

 This study showed a very minor difference in weight loss results when using a 40F bougie vs a 60F bougie.  At 6 months the difference was less than 2% and at 12 months the difference was less than 6%.

Study: Laparoscopic sleeve gastrectomy: does bougie size affect mean %EWL? Short-term outcomes. Surg Obes Relat Dis. 2008 Jul-Aug;4(4):528-33. doi: 10.1016/j.soard.2008.03.245.)

2013 Gastric Sleeve Surgery Study on Leaks

The results show that bougies of 40F and larger had incidents of leaks with virtually no change in weight loss.  Pending further research but caution is recommended in using the smallest possible bougie due to the risks outweighing the benefits.

(Study: The Effects of Bougie Caliber on Leaks and Excess Weight Loss Following Laparoscopic Sleeve Gastrectomy. Is There an Ideal Bougie Size? Obes Surg. 2013 Aug 3. [Epub ahead of print])

2012 Gastric Sleeve Study

Surgeons surveyed reported that in the range of 32F – 50F the most common size being used is 36F, (used by 32% of them).  Studies showed that the procedure is relatively safe while there are still variations in bougie size.

(Study: Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg. 2013 Aug 4. [Epub ahead of print])

What is the Best Bougie Size for Gastric Sleeve Surgery

Many variables determine bougie size including patient input, their height and weight and of course the surgeon.  It’s typically smaller when this is a stand alone procedure (32-50F) rather than a duodena switch (50-60F).

Depending on the bougie size the new stomach will be 60-80% smaller.  After surgery the new stomach will hold a meal of ½ cup to 1 ½ cups, rather than the normal 4 – 6 cups.

Before undergoing the sleeve gastrectomy procedure you must discuss bougie size with your surgeon.  You need to understand his reasons for recommending the size he intends to use.  It’s your stomach and you need to be comfortable.

The sleeve will help reduce hunger and limit food intake, but you need to follow a reduced calorie, nutrient-rich diet if you want to be successful.

Gastric Sleeve Surgery Complication: Leak

Gastric Sleeve Surgery Complication:  Leak—Become Knowledgeable About It

Gastric Sleeve leak
Gastric Sleeve Surgery Complications: LEAK

One of the newest weight loss surgeries being performed is gastric sleeve surgery.  It is performed on people who are obese with a body mass index of 35 or more.  When a person has this surgery it involves removing a portion of their stomach and followed by the creation of a thin vertical sleeve of stomach about the size of a banana.  The surgeon staples the stomach using a stapling device.  This is where the leak complications can happen.


What causes a leak in this area?


There are two main reasons that a leak can occur:


  • At the staple line there can be leakages due to intra-abdominal pressure
  • Because of a gap or hole that develops somewhere along the staple closure line


Complications from a leak


When a leak happens it can cause a severe infection from the leakage of gastric contents and gastric fluids.  This infection can lead to two very serious complications.


  • Septic shock—this is when you have low blood pressure with an injury to all of your body’s systems
  • Sepsis—this when you have adverse symptoms that involve all of your body systems


Either of these can cause major organ failure, which is when many of your organ systems quit working and in time it can lead to death.


How will you know if you have a leak?


There are many different symptoms that you can have if you have this complication.  After having gastric sleeve surgery your surgeon will go over everything with you including any possible complications and the symptoms they would produce.  The symptoms for a leak may include:


  • Pain in your abdomen that does not better but only gets worse
  • You have swelling in your stomach
  • Left shoulder or chest pain
  • Fever
  • Infection
  • Dizziness
  • Any appearance of being sick
  • Rapid heartbeat
  • Shortness of breath


You have a leak so how is it fixed?


Fixing this complication of gastric sleeve surgery involves either another surgery or putting in a drainage tube.


  • Normally surgery is the first and most common option since it hard to know if it is a leak or stomach bleeding from surgery. The surgeon will reopen the patient, close the hole, and clean up where it was leaking.  After surgery you will usually have to spend some time in Intensive Care to make sure that there are no more complications.  This second surgery will help to strengthen the staple line of the gastric sleeve.
  • Another option of fixing this complication is putting in a drainage tube to drain away the stomach acids.  During this time you will be fed either intravenously or using a catheter.  This will allow your stomach to heal so the leak will stop and also will help keep the stomach acids from reaching any other organs.


In Conclusion


This is a rare complication and occurs in one out one hundred patients.  It can be a life threatening complication if it is not taken care of so bottom line is if something does not feel right, seek immediate medical attention.