What is a TORe?

Transoral Outlet Reduction (TORe) is a minimally invasive revisional procedure designed for patients who have previously undergone Roux-en-Y gastric bypass. Typical patients may be experiencing weight regain or insufficient weight loss, others may be experiencing dumping symptoms.

How does the TORe work?

The initial gastric 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.

What does the procedure involve?

The TORe will be completed by Dr. Frey in about an hour at an outpatient surgery center under general anesthesia.

The procedure is endoscopic, which means no incisions are required. Instead, a flexible tube with a camera (endoscope) is inserted into the your stomach via your mouth.

How can this enhance my weight loss?

TORe patients generally have already achieved significant weight loss. Most studies show TORe patients lose an additional 10% of their weight. We know the TORe is most effective when accompanied by a lifestyle change or reset. Our Dietitian will assist you in making the correct dietary changes for ongoing success.

Who is the TORe suitable for?

The TORe is suitable for patients who:

• have tried resetting their diet and exercise, however, have not been able to keep the weight off

• have a BMI of ≥30

• have clinical evidence of enlarged gastric outlet or symptoms of dumping

How long will it take to recover from the TORe procedure?

You should plan at least three days of inactivity to recover from the procedure and to allow symptoms to resolve. We advise patients to wait until they are able to tolerate suitable volumes of fluid before resuming exercise to minimize the risk of dehydration. We encourage low to moderate intensity exercise during weeks 1-2 post-TORe, with a return to higher intensity exercise possible after one month.

Most patients are able to return to work within the week. You may be able to resume normal activity sooner or later than this depending on how quickly your body adjusts.

Will the TORe limit my activities?

During the first week of the procedure you should not plan any heavy activities. Once you are able to manage adequate amounts of fluids, you can continue your normal activities. Starting a regular exercise program is highly recommended and will improve your success.

Are there any other complications associated with the TORe?

Since this outpatient procedure is minimally invasive, the risk of complications is less than with revision surgery. You may have some mild stomach discomfort and nausea in the days after the procedure, and your doctor can prescribe medication for these side effects.

Very rarely, more serious complications could occur, including:

• Bleeding in the intestines or the stomach pouch

• Perforation

• Infection

• Stenosis (abnormal narrowing) of the gastric outlet

The gastric outlet can expand over time, and some people who have had TORe will need to repeat the procedure in the future.