Gastric Bypass Transoral Outlet Reduction: Endoscopic (TORe procedure)

Written by Mark Romportl, a Nurse Practitioner in Endocrinology and Bariatric Surgery

About 1 in 4 people who have bariatric (weight loss) surgery regain all of their weight back by 10 years out from surgery.  This is staggering!  All the hard work you may have put in before, during, and after the surgery, and still life can get in the way and weight can creep up.

One possible reason for this is dilation of the opening from the bottom of the stomach into the small intestine.

This can happen for a few different reasons:

• Overfilling the pouch or stomach with too much food
• Drinking carbonated beverages
• Drinking with eating
• Failure of the tissue to retain its normal shape and tightness over time

Signs that this may be happening to you could be that you notice you tolerate much more food volume than you once previously did.  You may also notice some weight regain as portions increase.  Gastrointestinal symptoms may worsen, and blood sugars may become low after meals.

If this describes you, the TORe procedure may be an option.  First, we would have you meet with:

• Endocrinology provider to discuss workup, the procedure, and follow up
• Dietitian to discuss food choices before the procedure and dietary progression after the procedure along with lifestyle optimization
• Behavioral psychologist to address the day-to-day life circumstances that may impact your relationship with food choices and activity levels

This same day procedure uses either suturing or laser techniques to make the opening into the small intestine smaller, keeping food in the stomach or pouch longer, leading to increased satiety (fullness) and additional restriction in how much food you can eat at one time.  By one year out from surgery, you may lose up to 10% of your total body weight.  Additionally, it is of utmost importance to keep up with follow up appointments with your healthcare team for accountability along the way to ensure weight stays off.

Complications are rare, but could include bleeding, dehydration, nausea and vomiting, constipation, and abdominal pain.

The anatomy shown here shows the suturing technique in a patient who has had a Roux-en-Y gastric bypass.