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Obesity is a serious progressive chronic disease resulting from various environmental, behavioral, and genetic causes. It’s serious because it is associated with poorer mental health outcomes and reduced quality of life. Obesity is also associated with the leading causes of death in the United States and worldwide, including diabetes, heart disease, stroke, and some types of cancer. 

Bariatric surgery, such as gastric bypass or sleeve gastrectomy, works by changing the anatomy of the stomach and small intestines. This causes changes in appetite, satiety, and metabolism. Most patients lose 50% or more of their excess body weight and keep this extra weight off long-term. Some weight regain is expected after the initial weight loss. However, some patients experience significant weight regain that can not be managed with diet and lifestyle interventions. This can be frustrating and can result in a loss of many of the health benefits of the initial surgery. Revisional surgery is an option but can be associated with a significant risk, and many patients are reluctant to undergo surgery again. A less invasive option is endoscopic bariatric revision. 

What is bariatric revision?

Bariatric revision, or trans-oral outlet reduction (TORe), is a non-surgical outpatient procedure. It is a corrective procedure for patients who have undergone gastric bypass surgery. 

With time, the gastric pouch and/or the gastric outlet (gastro-jejunal anastomosis) can stretch, resulting in weight regain. In endoscopic bariatric revision, sutures are used to tighten the gastric outlet and restore it to its original size. This results in weight loss. 

Endoscopic bariatric revision is performed through the mouth and does not involve surgery (it does not require any incisions). It is performed as an outpatient procedure and usually takes around half an hour. 

Who is bariatric revision for?

Bariatric revision is appropriate for patients who previously underwent gastric bypass surgery, but who are now experiencing weight regain.

An upper endoscopy is usually performed to evaluate the anatomy and assess the gastric pouch and the outlet size. After other causes of weight regain are excluded, and if the outlet is indeed enlarged, you may be a candidate for bariatric revision.

How does bariatric revision work?

The procedure is performed under sedation. The endoscopist advances an endoscope (a tube with a camera and a light on its tip) through the mouth to the gastric pouch. 

The scope is equipped with a suturing device (The Overstitch device) that is used to stitch and tighten the gastric outlet to restore it to its original size. This will restore the restriction and patients start feeling full with small portions again, which allows for the resumption of the weight loss. Patients spend a couple of hours in recovery and they go home the same day. After the procedure, patients are placed on a liquid diet that is then gradually advanced to a soft diet followed by a regular diet. Patients are provided with educational material as well as one on one support and nutrition follow-up visits to ensure patients have all the tools and support they need in their weight loss journey.

Is bariatric revision an easy procedure?

Bariatric revisions are low-risk, minimally invasive procedures.

  • The procedure itself takes around 30 minutes. 
  • This is an outpatient endoscopic procedure. 
  • It is not a surgery. 
  • It does not require admission to the hospital. 
  • There are no incisions or scars. 
  • It is performed under sedation. 

Patients may experience some soreness, fullness or nausea immediately after the procedure. Apart from that, the procedure is very well-tolerated. Patients usually need to be off work for two to three days then they can return to their usual activities. 

How much weight will be lost after a bariatric revision?

This procedure was designed to address the weight gain after gastric bypass. Weight loss can be variable and it depends on how much weight was regained and on the size of the outlet, among other factors.

Most patients will lose around 10% of their total body weight.

Weight loss is maintained long term, but the degree of weight loss depends on the adherence to dietary recommendations and lifestyle changes.

Bariatric revision can help improve several weight-related health conditions such as Type 2 diabetes, obstructive sleep apnea, fatty liver, and hyperlipidemia. 

In closing, if you have undergone gastric bypass surgery and are experiencing weight gain, or not achieving the necessary weight loss results, please get in touch with our team at The Silhouette Clinic for a free consultation and assessment. If you are a candidate for a bariatric revision, this simple outpatient procedure will address your current challenges, and your ideal weight loss results would finally be within reach.

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