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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 is a corrective procedure for patients who experience weight regain after having undergone gastric bypass surgery or gastric sleeve surgery. It is a minimally invasive, non-surgical procedure. 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 less than half an hour. The term bariatric revision includes 2 different procedures: gastric bypass revision, and gastric sleeve revision. 

 

Silhouette Team with credentials

 

 

What is Gastric Bypass Revision?

Endoscopic gastric bypass revision, or Transoral Outlet Reduction (TORe) is a procedure performed to address weight regain in patients with a history of gastric bypass surgery. With time, the gastric pouch and/or the gastric outlet (gastro-jejunal anastomosis) can stretch, resulting in weight regain. In endoscopic gastric bypass revision, sutures are used to tighten the gastric outlet and restore it to its original size. This results in weight loss.

 

How is a Gastric Bypass Revision Performed?

Endoscopic gastric bypass revision is an outpatient procedure. It does not require admission to the hospital. The gastric bypass revision is performed endoscopically through the mouth. You are given anesthesia, so you are fully asleep and you do not feel any pain. A scope is introduced through the mouth and advanced to the gastric pouch and gastric outlet. A suturing device is placed on the tip of the scope and stitches are placed in the outlet to bring it back to its original size. That is why this procedure is called Transoral Outlet Reduction, or the TORe procedure. If the pouch is dilated and gastric pouch tightening is needed, sutures can be placed in the pouch to decrease its size.

 

Is Gastric Bypass Revision Safe?

Endoscopic gastric bypass revision is an extremely safe procedure because it does not involve surgery. It is a quick endoscopic procedure and it does not involve any cutting. The risks are the risk of anesthesia, the risk of bleeding, and the risk of causing a tear that may need surgery. However, these risks are very rare.

 

How Long Does Gastric Bypass Revision Take?

The gastric bypass revision is a quick outpatient endoscopy. The procedure usually takes around 20 minutes. Patients are usually observed in the recovery area for about 2 hours then they are discharged home.

 

 

 

What is Gastric Sleeve Revision?

Endoscopic gastric sleeve revision is a procedure performed to address weight regain in patients with a history of gastric sleeve surgery (sleeve gastrectomy). With time, the gastric sleeve can stretch, resulting in weight regain. In endoscopic gastric sleeve revision, sutures are used to tighten the gastric sleeve and restore it to its original size. This results in weight loss.

 

How is Gastric Sleeve Revision Performed?

Endoscopic gastric sleeve revision is an outpatient procedure. It does not require admission to the hospital. The gastric sleeve revision is performed endoscopically through the mouth. You are given anesthesia, so you are fully asleep and you do not feel any pain. A scope is introduced through the mouth and advanced to the gastric sleeve. A suturing device is placed on the tip of the scope and stitches are placed in the gastric sleeve on both sides of the staple line to reduce the size of the sleeve and restore the restriction.

 

Is Gastric Sleeve Revision Safe?

Endoscopic gastric sleeve revision is an extremely safe procedure because it does not involve surgery. It is a quick endoscopic procedure and it does not involve any cutting. The risks are the risk of anesthesia, the risk of bleeding, and the risk of causing a tear that may need surgery. However, these risks are very rare.

 

How Long Does Gastric Sleeve Revision Take?

The gastric bypass revision is a quick outpatient endoscopy. The procedure usually takes around 20-30 minutes. Patients are usually observed in the recovery area for about 2 hours then they are discharged home.

 

 

 

Who is Bariatric Revision For?

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

You may be asking yourself: how do I qualify for a bariatric revision? An upper endoscopy is usually performed to evaluate the anatomy and assess the gastric pouch and the outlet size in case of a previous gastric bypass, or the gastric sleeve in case of a previous sleeve gastrectomy. After other causes of weight regain are excluded, and if the outlet or the sleeve are 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 or the gastric sleeve.

The scope is equipped with a suturing device (The Overstitch device) that is used to stitch and tighten the gastric outlet (or the gastric sleeve) 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 less than 30 minutes.
  • This is an outpatient endoscopic procedure.
  • It is not 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 Can I Lose With a Bariatric Revision?

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

Most patients will lose around 15% of their total body weight.

Weight loss is maintained long-term, but the degree of weight loss depends on 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.

 

Do You Perform Bariatric Revision Near Me?

Our endoscopic weight loss clinic is located in Montgomery County, Maryland, just outside of Washington, DC. We perform the gastric bypass revision and the gastric sleeve revision in Rockville, Maryland. However, we have patients coming to us from out of state all the time. You only need to come for your bariatric revision procedure. The remainder can be done online via video visits.

In closing, if you have undergone gastric bypass surgery or sleeve gastrectomy and are experiencing weight gain, or not achieving the necessary weight loss results, please get in touch with our team at The Silhouette Clinic to set up a 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 will finally be within reach.

 

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