TORe Procedure
(Gastric Bypass Revision)
Have you regained some of the weight you lost after your Roux-en-Y Gastric Bypass surgery? While gastric bypass surgery is considered the gold standard for weight loss procedures, weight regain is still possible. One common reason for this can be dilation (stretching) of the gastrojejunal anastomosis (outlet) created during your bypass surgery.
What exactly is the TORe Procedure?
The Transoral Outlet Revision (TORe) procedure is a minimally invasive, endoscopic solution designed for patients who have experienced weight regain after their initial Roux-en-Y Gastric Bypass surgery. One common reason for this can be dilation (stretching) of the gastrojejunal anastomosis (outlet) created during your initial gastric bypass surgery.
During the TORe procedure, an endoscope is used to tighten the gastric outlet created during previous Roux-en-Y Gastric Bypass surgery. This minimally invasive technique reduces the size of the outlet to about 1 cm, slowing food movement into the small intestine. As a result, patients experience increased fullness and reduced hunger, leading to weight loss. TORe is ideal for those who have regained weight after their initial surgery, offering a less risky alternative to traditional surgical revisions.
How does TORe (Gastric Bypass Revision) Work?
How does it help you lose the weight you have regained?
Restores Restrictive Effect
TORe (Transoral Outlet Reduction) revises the original gastric bypass by reducing the size of the stomach pouch or stoma, helping to reestablish the restrictive effect and promote weight loss.
Reduces Appetite and Improves Satiety
By narrowing the outlet between the stomach pouch and the small intestine, TORe can reduce appetite and increase feelings of fullness, aiding in the loss of regained weight.
What does the procedure involve?
TORe Procedure
The TORe (Transoral Outlet Reduction) procedure is a minimally invasive, same-day treatment performed under general anaesthesia, lasting about 60 minutes. During the procedure, your doctor inserts an endoscope through your mouth, guiding it to the stomach pouch for examination. A suturing device attached to the endoscope tightens the gastric outlet to enhance the restrictive effect of the original surgery.
Following the procedure, which requires no incisions, you won’t need an overnight hospital stay or worry about visible scars. Post-procedure, you might experience mild nausea or stomach discomfort, which is manageable with medication. Rare risks include bleeding, infection, or perforation, but overall, TORe presents a safer alternative to more invasive surgical options.
Why would you need a TORe Procedure (Gastric Bypass Revision)?
What causes weight regain after Gastric Bypass?
While gastric bypass surgery is highly effective for weight loss, some patients may experience weight regain due to dilation (stretching) of the outlet (gastrojejunal anastomosis) created at the time of their gastric bypass surgery. This occurs when the opening between the stomach pouch and the small intestine stretches over time, allowing food to pass through more quickly and leading to increased hunger.
Addressing this issue through surgical revision of a GJ anastomosis can be complex and carries risks. Alternatively, the TORe (Transoral Outlet Revision) procedure offers a non-surgical option with a lower risk profile, aiming to restore the effectiveness of the original bypass by tightening the gastric outlet.
Weight loss results with the TORe
What can I expect to achieve?
Evidence increasingly supports the safety and effectiveness of the TORe procedure. Typically, patients experience a 9-12% total body weight loss within the first year, translating to about 9-12 kg for someone starting at 100 kg. Long-term data further validates the procedure’s efficacy, with patients maintaining an 8.6% total body weight loss even 5 years post-procedure.
Frequently Asked Questions
Candidates for TORe are typically individuals who have had prior gastric bypass surgery and have experienced significant weight regain. Your surgeon will evaluate your specific condition to determine if TORe is the right option.
TORe offers several advantages, including smaller incisions, reduced pain, and faster recovery times compared to traditional open or laparoscopic revision surgeries. It is performed through the mouth using specialised instruments and robotics, minimising external scarring and potentially leading to a quicker return to normal activities.
TORe is generally performed as a day procedure (i.e. you can return home from hospital on the same day) and allows a return to daily activities within a few days. Patients may experience some throat discomfort and will need to follow a fluid diet initially, with a gradual return to normal foods over a number of weeks. Specific recovery times may vary based on individual circumstances.
As with any surgical procedure, TORe carries some risks, including infection, bleeding, or adverse reactions to anaesthesia. Specific risks related to TORe include damage to surrounding structures, difficulty with swallowing, or incomplete resolution of the initial problem. Your surgeon will discuss these risks with you and provide strategies to minimise them.
Preparation for TORe typically involves preoperative evaluations, such as imaging studies or endoscopies, to assess the condition of your stomach outlet. You will also receive instructions on fasting before the procedure and any necessary adjustments to your medications. Be sure to follow your surgeon’s preoperative guidelines closely.
The long-term outcomes of TORe can be positive if the procedure successfully resolves the issues with the stomach outlet. Many patients experience improved symptoms and better overall function. However, long-term success also depends on following post-surgical guidelines and maintaining a healthy lifestyle.
Yes, vitamin and mineral supplementation is typically required after a TORe Gastric Bypass Revision to ensure adequate nutrition. Common supplements include vitamin B12, iron, calcium, and vitamin D. Regular follow-ups with your healthcare provider will help monitor and manage any potential deficiencies.