What is TORe?

Endoscopic transoral outlet reduction (TORe) is a procedure for patients who develop problems after gastric bypass surgery, such as weight regain and/or dumping syndrome.

In gastric bypass surgery, the new stomach (known as the pouch) is joined to the small bowel. This new connection bypasses the rest of the stomach leading to weight loss. However in some cases the hole between the ‘pouch’ and the bowel (called the gastrojejunal anastomosis or GJA) increases in size (which leads to the recognised complications of weight regain and/or dumping syndrome).

TORe is an endoscopic procedure which means it is completed using an endoscope (or camera down the throat) rather than making surgical incisions (cuts) in the abdomen. During the procedure a device on the end of the endoscope is used to place sutures (stitches) internally across the GJA that was creating during the original bypass surgery. This shrinks the GJA to 1cm restoring the restrictions of the gastric bypass.

After a successful TORe procedure the rate that food can empty into the small bowel is reduced. This prevents fluid shifts and low blood sugar associated with Dumping Syndrome. It will also make the patient feel full quicker and for longer, to aid further weight loss.

Why TORe?

Reducing the size of the GJA can lead to a significant improvement in the symptoms of dumping syndrome and reverse post-surgery weight gain. On average, people can expect to lose 8-10% of their total body weight in the first year after having TORe and at least 6 out of 10 people will maintain 5% of total body weight loss after 5 years.

Surgery or TORe?

A revision of the gastric bypass could be completed with a surgical operation or laparoscopic (keyhole) surgery, but any surgery carries higher risks than a non-surgical endoscopic procedure, like TORe. The current research shows that the TORe procedure is safe and effective with a very low risk of complications during and after the procedure. As its less invasive patients can usually go home after 24 hours.

Consultant Gastroenterologist in London

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