Bariatric Revision

GI Surgical Specialists is Southwest Florida’s first practice to offer an Endoscopic Bariatric program. Our highly specialized surgeons perform endoscopic primary (ESG, Gastric Balloon) and revisional (TORe) bariatric procedures


Patients who regain weight after their initial weight loss surgery now have options

Have you started to regain weight after initial success from weight loss surgery (WLS)? Over time, the stomach pouch or the outlet that connects it to the small intestine can stretch (video). As a result, patients can eat more food before feeling full. We now offer a safe and effective endoscopic procedure to reduce your enlarged pouch and outlet to their original post-operative proportions.

Why would I regain weight after WLS?

Several studies suggest the majority of patients regain significant weight after WLS. A common cause includes gradual stretching of the stomach pouch or outlet. When the standard-of-care WLS procedures are performed, the stomach and outlet are made very small to reduce the amount of food consumed and slow the passage of food through the digestive tract. Together, this helps patients feel fuller, longer after eating just a small amount. As a result, weight loss occurs from a dramatic decrease in calories. Many clinicians have shown when the stomach pouch and/or outlet gradually stretch, it takes longer for the patient to feel full. As a result, patients may begin to regain weight.

Endoscopic outlet and pouch repair

We now offer qualified patients an endoscopic procedure (TORe) to reduce the volume of an enlarged pouch and the diameter of the outlet. This procedure is performed using a small flexible endoscope and specialized devices that allows sutures to be placed through the endoscope. The scope and suturing devices are inserted through the mouth into the stomach pouch the same way as a standard endoscope. Sutures are then placed around the outlet to reduce the diameter, typically from the size of a silver dollar to the size of a dime. The same technique may then be used to place additional sutures in the stomach pouch to reduce its volume capacity.

Video: Endoscopic Bypass Revision (TORe)

What are the benefits of the endoscopic procedure?

Scarring and adhesions from the initial WLS procedure often make open or laparoscopic revision surgery very challenging, and at times impossible. Abdominal revision surgery takes longer than the original WLS and patients are three times more likely to develop complications.

Having a revision through endoscopic procedure decreases the patient’s risks when compared to abdominal revision surgery. Patients experience less pain, recover faster, and have no abdominal scarring. Typically, patients go home the same day, but each patient’s discharge will vary based on the physician’s recommendation.

What are the side effects?

It is anticipated that patients will feel little or no discomfort from the endoscopic procedure. Minor side effects may include gas pain, nausea, sore throat, swollen tongue, and lip pain from the insertion of the endoscope into the mouth.

What is the recovery process?

Patients typically return to their normal routine within 48 hours. Following endoscopic outlet and pouch repair, patients should follow the same diet and exercise regimen they did after their initial weight loss surgery.

Will it be covered by insurance?

It depends upon the patient’s insurance plan. If not, cash pay options may be available. For further information, please speak with your physician at your next appointment.

Bariatric Surgical Revision

In rare occasions patients may require a revision of their original bariatric surgery. Common reasons include inadequate weight loss, acid reflux or heartburn or difficulty with swallowing, nausea or vomiting. Inadequate weight loss can happen with any procedure and determining the next steps requires a thorough evaluation including an endoscopy.

Acid reflux after a bariatric surgery more commonly is a consequence of having a sleeve gastrectomy, especially if you develop a hiatal hernia. This can only be corrected surgically. Difficulty with swallowing or vomiting can also happen as a consequence of any bariatric surgery and determining next steps requires a thorough workup.

If you are having any of the issues above after bariatric surgery, come see us for a complete evaluation and let us offer you the best minimally or non-invasive approach to get you to a better self.