Gastric bypass is one of the most effective tools we have for long-term weight loss. It is quite common for people to start gaining weight 2 years after the gastric bypass surgery. A large study on this topic found that 'excessive weight regain' (defined as ≥25% of total lost weight) occurs in 37% of patients.
Why Does Weight Regain Happen?
There's no single reason and usually a mix of factors:
- Anatomical changes: It has been found that dilation of the stomach outlet (surgical joint between gastric pouch and small bowel) over time can lead to increased food intake and weight regain. This prevents food from staying in the stomach for longer, making you hungrier sooner. Similarly the gastric pouch (remnant stomach) can stretch over time, allowing more food to be consumed at one time.
- Eating habits creeping back in: Snacking ("grazing"), high-calorie food intake
- Decreased physical activity
- Emotional eating
- Metabolism adjusting
For more information read the article Weight regain post gastric bypass.
What Is TORe/Outlet Reduction?
TORe stands for 'Transoral Outlet Reduction Endoscopy'. It's a minimally invasive, incision-free procedure performed using an endoscope. Using specialised suturing tools, the join between the stomach pouch and the small intestine (or in simple terms 'gastric outlet') is reduced to its original, smaller size.
This helps restore early satiety (the feeling of fullness), reduce hunger, and support renewed weight loss. It is also considered a great treatment for dumping syndrome post gastric bypass.
How Is TORe Done?
- Performed under anaesthesia
- Initially the gastric outlet is treated with thermal therapy to encourage long-term scarring.
- Then a suturing device called Overstitch attached to the endoscope is used to place stitches around the outlet, tightening it to an approximate size of ~7–8mm.
- The procedure usually takes 30–60 minutes and is performed as a day case.
- Patients can return home the same day and resume normal activities shortly after.
Benefits of TORe
- Non-surgical and low risk - No incisions, minimal recovery time
- Proven results - Studies show significant and sustained weight loss after TORe
- Restores fullness - Helps patients feel satisfied with smaller meals again
- Improves metabolic health - Can help control diabetes, blood pressure, and cholesterol
- Helps with symptoms of dumping syndrome, in particular hypoglycaemia post meals
- Supports long-term success - When combined with nutrition and lifestyle support
Variations of TORe
A lot of research is going into modifying and improving the technique. The focus is on maximising weight loss and improving long-term outcomes.
One such variation is combining the procedure with endoscopic dissection of gastric pouch followed by thermal treatment and suturing. This has shown better (~12–13% total body weight loss) results.
Who Is a Good Candidate?
You may be a good candidate for TORe if you:
- Had a Roux-en-Y gastric bypass
- Experienced weight regain or loss of restriction
- Experienced dumping syndrome (particularly low sugars/hypoglycaemia after meals)
- Have a dilated gastric outlet or pouch seen on endoscopy
- Are motivated to re-engage with healthy habits and follow-up care
The Takeaway
- Weight regain after gastric bypass can be discouraging - but it's not the end of your journey. TORe offers a proven, minimally invasive option to help you reclaim your results, restore your confidence, and restart your success story.
- If you've noticed weight regain or reduced restriction after your bypass surgery, you may benefit from an assessment for TORe.
- If you are experiencing dumping syndrome after your bypass surgery, you may benefit from an assessment for TORe.
Ready to Take the Next Step?
If you're interested in exploring TORe/outlet reduction further, book a consultation with Dr Fazal.
Phone: 07 3522 2900
Email: admin@gastroscope.clinic
Request an Appointment
This article is for educational purposes only and is not a substitute for medical advice. Always consult a qualified healthcare provider.