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Ask Dr. Ismael Bailon
Transoral Outlet Reduction
At The Center for Bariatrics, in Tijuana, Mexico, if you regain weight after gastric bypass surgery, transoral outlet reduction (TORe) can help you restart your weight loss program.
According to Ismael Bailon MD, FACS, “Transoral outlet reduction endoscopy (TORe) is a revisional therapy that can help manage weight regain after RYGB.”
What is transoral outlet reduction (TORe procedure)?
Transoral outlet reduction is a minimally invasive procedure that can help people who regain weight after gastric bypass surgery.
The bypass surgery creates a small pouch in the stomach and connects it to the small intestine, bypassing the rest of the stomach. Over time, the gastric outlet ― the opening between the gastric pouch and the small intestine ― can enlarge, and food will move into the small intestine faster, leaving you feeling hungry again. Studies have shown a correlation between an enlarging gastric outlet and weight gain.
TORe reduces the gastric outlet opening by accessing it through the mouth (transoral) with an endoscope (a thin flexible tube) and placing stitches (sutures) in the opening to tighten it. This slows down the emptying of food from the stomach, and it can help you feel full longer, so you eat less frequently and lose weight.
Who might need a transoral gastric outlet reduction?
People who regain weight after gastric bypass surgery may be candidates for this procedure when their body mass index (BMI) reaches or surpasses 30, which indicates obesity.
When diet and lifestyle changes do not work to restart weight loss, transoral gastric outlet reduction can help by making you feel fuller longer after eating.
Most patients achieve a loss of up to 70 percent of excess body weight within 2 years of having gastric sleeve surgery, with the most dramatic weight loss occurring in the first year following the procedure.*
This minimally invasive procedure involves much less risk than an open surgery revision of gastric bypass.
People who have transoral gastric outlet reduction can expect to lose about 10% of their excess body weight ― or more. Some people achieve a weight that is lower than their lightest weight after gastric bypass. Studies looking at the long-term effect of TORe have shown that weight loss can be maintained after five years.
Preparing for the TORe Procedure
To help evaluate your bypass and the plan for transoral gastric outlet reduction, Dr. Ismael Bailon probably will recommend an initial endoscopic examination of the inside of your stomach and the outlet leading to the intestines.
You will also need to follow Dr. Ismael Bailon’s specific preparation instructions, which may include a period of fasting or changing how and when you take medications before the procedure.
What happens during transoral outlet reduction?
Transoral outlet reduction takes place in an endoscopy suite while you are under anesthesia. It lasts about 60 minutes, and most patients go home the same day.
To perform transoral outlet reduction:
- Have a body mass index (BMI) of 40 or greater, or over 35 with one or more comorbidities (serious medical conditions caused by obesity, such as sleep apnea, heart disease, or Type 2 diabetes)
- Dr. Ismael Bailon inserts an endoscope into your mouth and guides it into the stomach pouch.
- The inside of the stomach is examined with the endoscope.
- Heat treatment is applied to the edge of the gastric outlet to help it narrow and close.
- Dr. Ismael Bailon uses a suturing device placed on the end of the endoscope to tighten the gastric outlet and reduce it to approximately 8 to 10 millimeters. Decreasing the opening’s size allows you to feel full and helps you lose weight.
- The endoscope is removed.
Transoral Outlet Reduction Recovery
After the TORe procedure, you will follow a special diet that transitions from liquids to soft foods over four weeks. Your doctor’s office will outline what, when and how you can resume eating.
If you have received a previous gastric bypass procedure, food in your system bypasses the stomach through a smaller gastric pouch with an outlet that connects directly to the small intestine. Overtime, the outlet size can stretch, allowing for food to empty out of the gastric pouch quicker.
The TORe procedure reduces the size of this outlet and will slow down the rate at which food exits the stomach. This will allow you to retain the feeling of fullness for longer, so your meals will satisfy your hunger for longer periods of time. Additionally, if it is found that the gastric pouch has stretched significantly, it may be appropriate to reduce the size of the pouch as well so that smaller meals can satisfy your hunger for longer as well.
On average, patients lost about 8.1-11% of their total body weight 6 months after receiving the TORe procedure. Some studies have shown that patients on average lost 8.8% of total body weight after 5 years. However, it is important to note that results will vary between each person. Committing to changing your habits and lifestyle will be extremely important to maximizing your results.
TORe is a non-invasive, incisionless procedure performed using a suturing device attached to a camera that is inserted through your mouth while you are asleep. After examining the area, the connection between the small stomach pouch and your intestines (the outlet) is reduced in size using the suturing device. In addition, the stomach pouch may also be reduced in size if needed.