Gastric revision surgery

Gastric Bypass Revision (Transoral Outlet Reduction)

Gastric bypass is one of the most common bariatric surgeries in which a large portion of the stomach and the first part of the small bowel is diverted, creating a small stomach pouch attached directly to the small intestine. This stomach pouch can get bigger over time along with the connection site to the small bowel called the “outlet,” allowing patients to eat more before feeling full. The majority of patients will eventually regain weight after the surgery and more than 20% will actually regain the entirety of the weight lost. With endoscopic gastric bypass revision, we are able to tighten this outlet and the stomach pouch (if needed) by placing sutures in a minimally invasive way. Compared to surgery, this is an incisionless approach that will allow you to return to that sense of fullness and to lose the weight you previously lost with minimal risk.

What is Transoral Outlet Reduction (TORe)?

The TORe procedure is a minimally invasive, incisionless and same-day outpatient endoscopic weight loss procedure that is performed to reduce the size of the outlet and in some cases the stomach pouch as well. This will allow you to re-experience the early fullness as you did after the original bariatric surgery and lose the weight that may have been regained. It is also highly effective in maintaining the weight loss as this is a permanent revision in reducing the outlet size.

To be a candidate, you must be of at least 21 years of age (as authorized by the FDA) with a body mass index (BMI) of at least 30 (calculate your BMI ). You must be at least two years from your gastric bypass surgery and have experienced that the weight you initially lost is now being regained back. You will have a consultation with the doctor to review your medical history to determine if you are a candidate for TORe prior to scheduling the procedure. We encourage you to ask any and all questions you may have regarding the procedure during this office visit. TORe is a great option for those who want to avoid surgical revision or for those who are not candidates for surgical revision. Results are also optimal if you are motivated to commit to an ongoing healthy lifestyle, which includes dietary modifications and exercise.

Are you a candidate?

The procedure is a minimally invasive, and incisionless endoscopic procedure that usually takes less than 30 minutes. While you are sedated, your physician will insert a small camera attached to a thin and flexible tube through your mouth and into your stomach. A suturing device is connected to the tube, enabling stitches to be placed around the outlet and in some cases the stomach pouch itself. When these sutures are placed and pulled, the size of the outlet and gastric pouch will reduce in size, allowing you to restore the feeling of fullness, eat less, and ultimately lose weight again.

Are you a candidate?

How is TORe performed?

How much weight can you expect to lose?

Estimated weight loss from bariatric bypass revision procedure is about 10-15% of total body weight following the procedure. These results are optimized when in conjunction with following a low fat diet and adequate exercise. There are other health benefits in addition to weight loss which include improvement in high blood pressure, type 2 diabetes, high cholesterol, fatty liver, and obstructive sleep apnea. Importantly, this is a permanent and non-surgical approach in restoring the original size of the stomach pouch and outlet.

What can you expect after the procedure?

Most patients will experience mild symptoms after and for a few days following the procedure including abdominal discomfort and nausea. These symptoms will usually disappear after your body becomes used to your reduced stomach size and outlet again. There are medications that we will prescribe you before and after your procedure to help with these symptoms. As compared to surgery, the possibility of complications are drastically reduced. Symptoms to be aware of that will require medical attention will be thoroughly discussed at your visit and prior to your procedure.

Will you have any dietary/activity exercises after the procedure?

Yes, now that your stomach has again shrunken in size and the outlet to the small intestine is smaller, you will not be able to eat the same quantity of food that you were prior to your procedure. You will be given a booklet with dietary recommendations regarding what you should and should not eat for the coming days to weeks after the procedure while your stomach accommodates to its new size. In addition to dietary modifications, we will also assist you in exercise planning with trained experts that will work with you individually to track your progress. These lifestyle changes are aimed to be lifelong to help you maintain the weight loss that we will work hard with you to help lose.

Why should you choose us?

Endoscopic gastric bypass revision is a complex endoscopic procedure that should be performed by highly skilled gastroenterologists. We at 4ward Wellness are advanced endoscopists who have completed additional training in complex and high risk endoscopic procedures. We possess the skills and tools to not only perform these procedures but to also manage the unlikely risk of potential complications associated with any endoscopic procedure. Rooted in the Capital Region, we are proud to offer an individualized approach in achieving your weight loss goals. We are here to listen to you and work with you to help choose the best option in the next step in your journey in losing weight and achieving wellness to overall live a healthier life.

Follow-up

Remember, this is not just a one-time visit, but is rather a long-term journey. You will return the next day to receive IV fluids at our infusion center. We will check in at this time about how you are feeling. You will also have scheduled follow up in the office soon after the procedure and then once every couple months for up to a year. In the 1 year following your procedure, you will also have concierge aftercare. This will include weekly calls with a board certified bariatric counselor/nutritionist and 24/7 access for any questions or concerns to provide you with the tools you need in this next chapter of your life.

How much does TORe cost?

The gastric bypass revision procedure costs $9,999. This cost not only covers the procedure but also your journey to wellness consisting of post procedure follow-up appointments and concierge aftercare with 24/7 access for up to one year. These procedures are not currently covered by all insurance companies. We understand financial limitations can be a barrier to undergoing elective treatments to improve your health. We offer various financing options including Care Credit to help you move 4ward in your wellness journey.

Are you from out of town?

We at 4ward Wellness welcome patients from anywhere, and we know it is crucial to have the right accommodation when visiting us. Located 20 minutes from Albany International Airport, 4ward Wellness have partnered with these hotel(s) (Hyperlink). If you wish to stay elsewhere, our friendly staff will help you find accommodation that is suitable for your needs. When travelling, all patients must have a responsible adult accompanying them. Let us know how we can help.

Pricing

Initial Consultation

$99*

ESG

$11,999*

Initial office consultation
ESG Procedure (includes: facility, anesthesia and physician fees)
Up to 1 year of bariatric nutrition/lifestyle counselling
24/7 direct physician access
Post procedure IV hydration

Bariatric Revisions

$9,999*

Initial office consultation
- Revision procedure (includes: facility, anesthesia and physician fees)
Up to 1 year of bariatric nutrition/lifestyle counselling
24/7 direct physician access
Post procedure IV hydration

Gastric Balloons

$9,999*

Initial office consultation
ORBERA Procedure (Includes: facility, anesthesia and physician fees)
Up to 1 year of bariatric nutrition/lifestyle counselling
24/7 direct physician access
Post procedure IV hydration