Bariatric revision using the Transoral Outlet Reduction (TORe) procedure is a minimally invasive endoscopic treatment performed to help patients who have regained weight after a prior gastric bypass surgery.
Over time, the connection between the stomach pouch and the small intestine (the gastrojejunal anastomosis) can stretch, allowing food to pass more quickly and reducing the feeling of fullness. The TORe procedure uses an endoscope with a specialized suturing device to reduce the size of this connection and, in some cases, the stomach pouch itself.
By narrowing the outlet, the procedure slows gastric emptying and helps restore early satiety, supporting renewed weight loss without the need for surgical revision.
Reasons for the TORe procedure
Your physician may recommend a TORe procedure for the following reasons:
- Weight regain after Roux-en-Y gastric bypass surgery
- An enlarged gastrojejunal anastomosis (widened stomach outlet)
- Loss of restriction or early satiety after prior bariatric surgery
- Difficulty maintaining long-term weight loss after gastric bypass
- Recurrence of obesity-related health conditions
- Evaluation of post-bypass symptoms with documented anatomical changes
Eligibility for TORe is determined after a full medical and endoscopic evaluation.
Reasons for a repeat or additional revision
A repeat or additional endoscopic revision may be recommended to:
- Further reduce a persistently enlarged gastric outlet
- Enhance the weight-loss response if initial treatment is incomplete
- Address recurrent weight regain
- Optimize restriction over time
- Evaluate or treat changes in anatomy after a prior revision
Benefits of the TORe procedure
TORe provides a non-surgical option to improve weight control after gastric bypass failure or weight regain. Benefits include:
- A minimally invasive, endoscopic procedure
- No external incisions
- Revision of prior bariatric surgery without open or laparoscopic surgery
- Restoration of stomach restriction
- Improved early satiety (feeling full sooner)
- Support for renewed weight loss
- Shorter recovery time compared with surgical revision
Potential health benefits of renewed weight loss
- Improved blood sugar control
- Reduced blood pressure
- Improved cholesterol levels
- Decreased fatty liver disease
- Reduced sleep apnea symptoms
- Improved mobility and joint pain
- Enhanced overall quality of life
How to prepare
Please inform your healthcare team if you have heart disease, lung disease, diabetes, bleeding disorders, a history of prior gastric bypass or bariatric procedures, acid reflux or ulcer disease, allergies to medications, or any other significant medical condition.
- Do not eat or drink anything for at least 8 hours before the procedure.
- Inform your physician of all medications you are taking.
- Follow instructions regarding blood thinners, antiplatelet medications, insulin, and diabetic medications.
- Complete any required pre-procedure evaluations or nutritional counseling.
- Arrange for a responsible adult to drive you home after the procedure.
What to expect during the procedure
- An intravenous (IV) line will be started.
- You will receive general anesthesia or deep sedation for comfort.
- An endoscope with a suturing device is passed through the mouth into the stomach.
- The physician identifies the gastric pouch and gastrojejunal anastomosis.
- Sutures are placed to reduce the size of the gastric outlet and, when needed, the pouch.
- No external incisions are required.
- The procedure generally takes approximately 60 to 120 minutes.
- You will be monitored in a recovery area after completion.
After the procedure
- Most patients go home the same day or after a short observation period.
- Mild abdominal discomfort, nausea, bloating, or fatigue may occur for several days.
- A structured diet progression will be required, starting with liquids and gradually advancing to solid foods.
- Anti-nausea and acid-reducing medications may be prescribed.
- Regular follow-up with your physician and nutrition team is essential for success.
Contact your physician if you experience
- Severe abdominal pain
- Persistent vomiting
- Fever or chills
- Difficulty swallowing
- Chest pain or shortness of breath
- Signs of dehydration
- Gastrointestinal bleeding (vomiting blood or black stools)
Risks and possible complications
TORe is generally safe when performed by experienced endoscopists, but complications may occur. Possible complications include:
- Abdominal pain or cramping
- Nausea and vomiting
- Bleeding
- Infection
- Narrowing of the gastric outlet that is too tight (stricture)
- Ulcer formation at the revision site
- Perforation (rare)
- Adverse reactions to anesthesia or sedation
- Dehydration during recovery
Although serious complications are uncommon, they may require medical treatment, hospitalization, or additional procedures.
Understanding long-term success
TORe is a tool to support weight loss after prior bariatric surgery and is most effective when combined with long-term lifestyle changes. Successful outcomes depend on:
- Following dietary recommendations
- Eating small, protein-focused meals
- Avoiding high-calorie liquids and snacks
- Regular physical activity
- Ongoing nutritional counseling and follow-up care
- Behavioral and lifestyle modifications
- A commitment to long-term weight management
Weight loss typically occurs gradually over the months following the procedure, with the best results in patients who adhere closely to post-procedure guidelines.