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Gastric Bypass Revision

What is Gastric Bypass Revision?

Gastric bypass revision, or Trans-oral Outlet Reduction (TORe), is a non-surgical outpatient procedure. Sutures are used to tighten the gastrojejunal anastomosis and restore it to its original size in patients experiencing weight regain after gastric bypass.

Who is gastric bypass revision for?

Gastric bypass revision is suited for patients who previously underwent gastric bypass surgery (Roux-en-Y Gastric bypass or RYGB), but who are now experiencing weight gain.

 

How does gastric bypass revision work?

Gastric bypass revision is an outpatient endoscopic procedure. It is not a surgery. There are no incisions or scars. The endoscopist advances an endoscope (a tube with a camera and a light on its tip) through the mouth to the stomach pouch. The scope is equipped with a suturing device that allows us to suture the gastrojejunal anastomosis as well as the gastric pouch to restore them to their original size. This is performed under sedation. It does not require admission to the hospital. After the procedure, the patient will start feeling full after smaller meals again, which helps with weight loss.

 

How long does an endoscopic gastric bypass revision procedure take?

Endoscopic gastric bypass revision is a quick outpatient procedure. The procedure itself takes less than half an hour. You will need to present to the outpatient surgery center an hour before your procedure time. After your bypass revision, you will be monitored in the recovery area for 1-2 hours. Then you are discharged home.

 

What is the recovery after bypass revision?

After your endoscopic gastric bypass revision, you will recover in the surgery center for an hour or two, then you will go home. You will need someone to drive you home, as you are not allowed to drive for 24 hours after receiving anesthesia. The first day or two after your bypass revision, you may experience some nausea or pain in your upper abdomen. You will be provided with medications to treat these symptoms if they occur. We usually recommend that you take 2-3 days off work after undergoing endoscopic gastric bypass revision. After that, you can go back to work and to your usual routine. We may recommend against heavy lifting and some strenuous activities in the first-week post-revision.

 

What is the diet like after endoscopic gastric bypass revision?

You will progressively advance your diet after your revision, just like you did after your initial gastric bypass surgery. You will be on a clear liquid diet for two days then gradually advance to a full liquid diet for a couple of weeks then to a soft diet for a couple of weeks then you can go back to a regular consistency diet.

 

What are the benefits of endoscopic gastric bypass revision?

Compared to surgical gastric bypass revision, endoscopic bypass revision carries many advantages. Most patients who had a previous bariatric surgery, do not want to undergo another surgery. Endoscopic revision is ideal for these patients as it is performed through the mouth without surgery, incisions, or scars. The endoscopic gastric bypass revision also carries much less risk than the surgical bypass revision. It involves suturing only without cutting the stomach or the bowel. The procedure is performed as an outpatient and does not require hospital admission, and the recovery is very fast. The endoscopic revision restores the potential for weight loss from the initial gastric bypass surgery.

What evaluation is required before the gastric bypass revision procedure?

We may recommend that you undergo an upper endoscopy (EGD) to determine whether you would benefit from a gastric bypass revision. We would need to evaluate your gastric pouch and outlet. If dilation has occurred with time, it can be corrected endoscopically with suturing during an endoscopic bypass revision. We may also require some basic blood tests before you undergo anesthesia. Additional tests or clearance may be required if you have certain medical conditions.

What are the risks of the gastric bypass revision procedure?

Endoscopic gastric bypass revision is a very safe procedure. After the procedure, you may experience some upper abdominal pain and nausea. These are usually controlled with medications and they resolved in 1-2 days. More serious possible complications such as bleeding, leak, or infection are extremely rare.

How do you keep the weight off after gastric bypass revision?

After your revision, we work with you to adopt a healthy diet and an active and healthy lifestyle. Long-term weight loss results require work, dedication, and commitment. Our team is there for you to help you through the process and to provide you with the tools you need for success. Our team is there to help patients get back on track, implement the necessary lifestyle changes, and improve their exercise habits. Our comprehensive after-care program includes medical and nutrition support and monitoring. Our bariatric dietitians meet with you every month and they are always available to answer any questions you may have.

Get your weight loss journey back on track with gastric bypass revision!

Gaining weight back after having lost it with much effort and hard work after gastric bypass surgery can be disheartening and very frustrating. If you experienced weight regain after your gastric bypass surgery, consider bariatric revision, and contact us at: (301) 288-1319 to schedule an appointment check see if you may be a candidate.

More Questions:

How does endoscopic bariatric revision surgery compare to traditional revisional surgery?

Endoscopic gastric bypass revision is minimally invasive and involves using an endoscope to access the stomach pouch and outlet through the mouth. It does not involve any incisions or cutting and it is performed as an outpatient weight loss procedure. Traditional Revisional Surgery is either open or laparoscopic surgery. it is more invasive and is performed as an inpatient surgery in the hospital. The endoscopic revision provides a quicker recovery time and a lower risk of complications. The endoscopic procedure is as effective as the surgical revision. Patient selection is very important, as some patients may not be candidates for the endoscopic revision and an open revision surgery is needed. 

How soon after weight loss surgery may I get a bariatric surgery revision?

It is not unusual for patients to experience some weight gain in the first 3 years after the original procedure. Most of the initial weight gain is metabolic and hormonal in origin and does not require and revision procedure. An endoscopy can be performed to assess the size of the stomach pouch and the outlet to the small intestine to determine whether the patient is a candidate for revision surgery. Patients who regain weight several years after the initial bariatric surgery are more likely to benefit from a revision to reduce the size of the stomach pouch. 

Does the Trans-oral Outlet Reduction procedure require a bariatric surgeon to perform?

A weight loss surgeon performs a bariatric procedure such as a gastric bypass or a gastric sleeve. However, endoscopic revision (TORe) is typically performed by a gastroenterologist or a surgeon skilled and experienced in endobariatric procedures. 

Can a revisional weight loss surgery be performed after a gastric sleeve?

Weight regain can be a problem for many patients who had a previous weight loss surgery including gastric bypass patients as well as sleeve gastrectomy patients. The reasons for unsatisfactory weight loss may be hormonal and metabolic resulting in weight gain, and they can be related to stretching of the stomach. In such cases, a revisional bariatric surgery or an endoscopic revision may be necessary to reduce its size and restart the weight loss. 

Can a weight loss revision be performed after a gastric band weight-loss surgery?

Patients who undergo the lap band surgery are less likely to reach their weight loss goals and they are at higher risk of suffering from complications related to the band. Band revision is not performed but the band can. be removed and another weight loss surgery performed.