What is Transoral Outlet Reduction (TORe)?
TORe is a minimally invasive endoscopic procedure designed specifically for patients who have experienced weight regain after Roux-en-Y gastric bypass surgery. The procedure reduces the size of the dilated gastrojejunal anastomosis (the connection between the stomach pouch and small intestine) using endoscopic suturing.
Over time, this anastomosis can stretch from its original 10–12mm diameter to over 25–30mm, allowing food to pass through too quickly and reducing satiety. TORe restores this restriction without surgery.
How Does the Anastomosis Dilate?
The anastomosis can dilate due to:
- Natural tissue relaxation over time
- Repeated stretching from overeating
- Gravity and mechanical forces
- Individual healing responses
This dilation is one of the most common anatomical causes of weight regain after gastric bypass.
The TORe Procedure Step by Step
- The procedure is performed under general anaesthesia
- An endoscope is passed through the mouth into the gastric pouch
- The dilated anastomosis is identified and measured
- Using a specialised endoscopic suturing device, full-thickness sutures are placed around the rim of the anastomosis
- The sutures are cinched to reduce the outlet diameter to approximately 8–10mm
- The procedure takes 45–60 minutes
Who is a Candidate for TORe?
- Patients who had Roux-en-Y gastric bypass and regained significant weight (typically >15% of lost weight)
- Patients with a dilated anastomosis (>15mm confirmed by endoscopy)
- Those seeking a non-surgical alternative to revisional bariatric surgery
- Patients committed to dietary and lifestyle modifications post-procedure
Expected Results
- Average total body weight loss of 8–10%
- Improved satiety and reduced portion sizes
- Improvement in obesity-related comorbidities
- Results are enhanced when combined with dietary counselling and behavioural support
TORe vs Revisional Surgery
TORe Advantages
- No incisions required
- Shorter recovery (2–3 days)
- Lower complication rate
- Can be repeated if needed
- Performed as a day procedure
Revisional Surgery Considerations
- Requires general anaesthesia and hospital stay
- Higher complication rate (10–15%)
- Longer recovery (4–6 weeks)
- May be necessary for complex anatomical issues
Recovery and Follow-Up
- Liquid diet for 1–2 weeks, then gradual return to soft and regular foods
- Most patients return to work within 2–3 days
- Follow-up endoscopy may be recommended at 3–6 months
- Ongoing dietetic support is provided
