Renew Your Weight-Loss Journey — Without Another Surgery

Endoscopic Revisional Procedures

Bariatric surgery can be a powerful tool for achieving significant weight loss and improving your health. But your body can change over time.

For some patients, the stomach pouch, gastric outlet or sleeve created during a previous weight-loss surgery can gradually stretch or enlarge. When this happens, you may be able to eat larger portions before feeling full, and some of the weight you worked so hard to lose may return.

That doesn’t necessarily mean you have to undergo another surgery.

At Columbus Regional Healthcare System, advanced endoscopic revisional procedures offer minimally invasive options for certain patients who have experienced weight regain following previous bariatric surgery.

Performed through the mouth using a flexible endoscope, these procedures can help restore some of the restriction created by your original bariatric procedure — without new abdominal incisions.

Two Procedures. One Goal.

The type of endoscopic revision that may be appropriate for you depends primarily on the bariatric procedure you’ve previously had.

Had Gastric Bypass?

Transoral Outlet Reduction (TORe) may be an option.

TORe is designed for certain patients who have experienced weight regain following Roux-en-Y gastric bypass.

Had Sleeve Gastrectomy?

Sleeve-in-Sleeve may be an option.

Sleeve-in-Sleeve is designed for certain patients who have experienced weight regain following sleeve gastrectomy.

Your care team will evaluate your individual anatomy, health history and weight-loss journey to determine whether an endoscopic revision or another treatment option is right for you.

Transoral Outlet Reduction (TORe)

A Minimally Invasive Revision After Gastric Bypass

Roux-en-Y gastric bypass creates a small stomach pouch that connects to the small intestine through an opening known as the gastric outlet.

Over time, this opening may enlarge in some patients. A larger outlet can allow food to leave the stomach pouch more quickly and may reduce the feeling of fullness that helped with weight loss following the original procedure.

Transoral Outlet Reduction, or TORe, is an endoscopic procedure designed to reduce the size of an enlarged gastric outlet.

During TORe, your physician passes a flexible endoscope through your mouth and into the stomach pouch. Using specialized endoscopic techniques, the enlarged outlet can be reduced to help restore restriction.

There are no new abdominal incisions and the procedure does not require repeating the original gastric bypass surgery.

How Can TORe Help?

By reducing the diameter of an enlarged gastric outlet, TORe is intended to help restore the feeling of fullness after eating and support renewed weight loss.

Potential benefits include:

• No new abdominal incisions
• Performed through the mouth
• Minimally invasive alternative to surgical revision for appropriately selected patients
• Helps restore restriction following gastric bypass
• Shorter recovery compared with traditional revisional surgery
• Works alongside nutrition, physical activity and lifestyle changes to support renewed weight loss

Who May Be a Candidate for TORe?

TORe may be considered for patients who:

• Previously underwent Roux-en-Y gastric bypass
• Initially lost weight but have experienced significant weight regain
• Have an enlarged gastric outlet or other anatomical changes that may be contributing to weight regain
• Have struggled to achieve adequate results through lifestyle changes alone
• Are committed to nutrition, physical activity and ongoing follow-up

Not every patient who experiences weight regain following gastric bypass will be a candidate for TORe. A comprehensive evaluation can help determine what’s contributing to your weight regain and which treatment option may be most appropriate.

Sleeve-in-Sleeve

A Minimally Invasive Revision After Sleeve Gastrectomy

Sleeve gastrectomy reduces the stomach to a narrow, sleeve-like shape, helping you feel full with smaller portions.

Over time, however, the remaining stomach can stretch or enlarge in some patients. This may allow you to eat larger portions before feeling satisfied and can contribute to weight regain.

Sleeve-in-Sleeve is an endoscopic revisional procedure designed to reduce the volume of an enlarged gastric sleeve without another abdominal surgery.

During the procedure, your physician passes a flexible endoscope through your mouth and into the stomach. Specialized sutures are placed from inside the stomach to create folds, or plications, that tighten the existing sleeve and reduce its volume.

In essence, the procedure creates a smaller sleeve within your existing gastric sleeve — which is where the name “Sleeve-in-Sleeve” comes from.

How Can Sleeve-in-Sleeve Help?

By reducing the volume of an enlarged gastric sleeve, Sleeve-in-Sleeve can help restore restriction and support renewed weight loss.

Potential benefits include:

• No new abdominal incisions
• Performed entirely through the mouth
• No additional portion of the stomach is surgically removed
• Helps restore restriction to an enlarged gastric sleeve
• Minimally invasive alternative to surgical revision for appropriately selected patients
• Shorter recovery compared with traditional revisional surgery
• Supports renewed weight loss when combined with healthy lifestyle changes

Who May Be a Candidate for Sleeve-in-Sleeve?

Sleeve-in-Sleeve may be considered for patients who:

• Previously underwent sleeve gastrectomy
• Initially achieved weight loss but have experienced significant weight regain
• Have experienced enlargement or stretching of the gastric sleeve
• Prefer a minimally invasive approach when clinically appropriate
• Are committed to making the nutrition and lifestyle changes necessary for long-term success

Your care team will evaluate your current anatomy and health history to determine whether Sleeve-in-Sleeve is appropriate for you.

Weight Regain Doesn’t Mean You Failed

Weight regain following bariatric surgery can be frustrating — especially after you’ve worked hard to achieve significant weight loss.

But obesity is a complex, chronic disease, and weight recurrence can happen for many reasons. Changes in anatomy, metabolism, medications, eating patterns, physical activity and other factors can all play a role.

Experiencing weight regain does not erase the progress you’ve made.

Instead, it may be a sign that it’s time to reassess your treatment and determine whether another tool could help you move forward.

More Than a Revision

An endoscopic revision is a tool — not a replacement for the habits and support that contribute to long-term success.

That’s why the Weight Loss Surgery program at Columbus Regional Healthcare System takes a comprehensive approach to your care.

Your treatment plan may include:

• Evaluation of your previous bariatric procedure
• Review of your weight history
• Nutrition counseling
• Lifestyle and behavioral support
• Medical weight management when appropriate
• Endoscopic treatment
• Surgical options when appropriate
• Continued follow-up with your weight-management team

The goal is to understand why you’re experiencing weight regain and develop a treatment plan that’s right for you.

Which Endoscopic Revision Is Right for Me?

If you’ve had Roux-en-Y gastric bypass:

TORe may help reduce an enlarged gastric outlet and restore restriction.

If you’ve had sleeve gastrectomy:

Sleeve-in-Sleeve may help reduce the volume of an enlarged gastric sleeve and restore restriction.

The right treatment depends on your anatomy, previous surgery, health history, weight-loss goals and the reasons you’re experiencing weight regain.

Your Journey Isn’t Over.

If you’ve regained weight following bariatric surgery, you may have more options than you realize.

Advanced endoscopic revisional procedures can give appropriately selected patients another tool for achieving their weight-loss goals — without undergoing another traditional abdominal surgery.

Schedule a consultation with the Columbus Regional Healthcare System Weight Loss Surgery team to learn whether TORe, Sleeve-in-Sleeve or another weight-management option may be right for you.