Rush offers endoscopic bariatric surgery revision options in Chicago and the surrounding area, including endoscopic revision of gastric bypass (also known as TORe), and laparoscopic sleeve gastrectomy revision procedures. If you’ve had weight loss surgery in the past and regained weight, endoscopic bariatric revision can help you lose weight, address complications and achieve lasting results.
What Are Endoscopic Bariatric Revision Procedures?
Endoscopic bariatric revisions are minimally invasive procedures to address weight regain after weight loss surgery.
Over time, a gastric bypass or sleeve gastrectomy may become dilated or “stretched out.” If this happens, the ability of the surgery to restrict food intake may be reduced or lost. Often, patients who have this problem will notice they can eat larger portion sizes than they could initially after the surgery. The loss of restriction results in increased calorie intake and weight regain.
Endoscopic bariatric revision procedures use an endoscopic suturing device that is passed through your mouth and esophagus. This device is used to re-tighten the dilated gastric bypass or sleeve gastrectomy. This re-tightening procedure can bring back the restriction lost over time and helps with re-learning portion control.
The procedures are generally done in an outpatient setting, meaning you can go home the same day. Endoscopic bariatric revision procedures take around 45 minutes to complete. Because these procedures are performed without incisions or cuts, they avoid issues with scar tissue or fibrosis.
Rush offers endoscopic, minimally invasive procedures without incisions for bariatric revision, alongside surgical options. Your providers will work together to create a treatment plan personalized for you.
Meet our endoscopic bariatric revision specialists
Common Reasons for Endoscopic Bariatric Revision Procedures
There are several reasons your provider may recommend a bariatric revision procedure, including:
- Weight regain: Bariatric surgery is currently the most effective option for weight loss. However, weight regain is common several years after bariatric surgery. The most common weight loss surgeries reduce the size of your stomach by creating a pouch or sleeve, resulting in less space for food. Over time, the remaining stomach can stretch and can lead to loss of restriction, increased dietary intake and weight regain. Endoscopic bariatric revision procedures can correct this and return lost restriction.
- Complications: Endoscopic procedures can also correct complications from previous surgeries, including dumping syndrome, gastrogastric fistulas, gastroesophageal reflux disease (GERD) and ulcers.
- Insufficient weight loss: If you have not lost the weight you expected after bariatric surgery, your provider may recommend an evaluation to see if you are a candidate for endoscopic bariatric revision.
Types of Endoscopic Bariatric Revision Procedures at Rush
Rush bariatric surgeons offer several types of revision procedures. Your options will depend on the type of surgery you had initially and your goals.
- Endoscopic revision of bariatric surgery: These are nonsurgical, minimally invasive endoscopic procedures. If you’ve had bariatric surgery and you have lost restriction or are concerned your stomach has expanded, this procedure may be able to help. Your doctor will insert a thin tube with a camera, called an endoscope, through your mouth and throat. Then, if you are a candidate for the revision procedure, they will place stitches to reduce the size of your stomach.
- TORe revision: Transoral outlet reduction, or TORe, is a type of endoscopic procedure designed to address weight gain after Roux-en-Y gastric bypass. After a gastric bypass, the opening (also known as anastomosis) between your stomach pouch and small intestine can expand. During a TORe revision, your provider will use a small scope with the suturing device to stitch this opening tighter. This slows down the emptying of food for the stomach and increases restriction.
- Sleeve gastrectomy revision: This procedure can address complications after a laparoscopic sleeve gastrectomy. Similar to gastric bypass, over time the sleeve can become dilated or stretched out and the restriction that was initially present may become reduced or lost. Restriction is the primary mechanism for weight loss after sleeve gastrectomy. Endoscopic revision is often performed to address this dilation and can re-tighten the sleeve to help provide restriction again.
Benefits of Endoscopic Bariatric Revision Procedures
Endoscopic bariatric revision procedures can help you progress toward your health goals or heal painful complications. These are some potential benefits:
- Endoscopic bariatric revision can kickstart stalled weight loss or reverse weight gain.
- Revision procedures can treat dumping syndrome, fistulas, ulcers or severe acid reflux caused by previous surgery.
- Many procedures are minimally invasive or endoscopic. These procedures allow you to recover faster, with most patients being discharged home the same day.
- Endoscopic procedures do not use incisions, and are less likely to have complications due to previous scar tissue or fibrosis.
- Continued weight loss can improve conditions like diabetes, sleep apnea, high blood pressure, fatty liver disease and acid reflux.
Are Endoscopic Bariatric Revision Procedures Right for Me?
Your doctor may recommend an endoscopic bariatric revision procedure if:
- You have regained weight after gastric bypass, sleeve gastrectomy or lap band surgery
- You have dumping syndrome, gastric fistula, severe acid reflux, or ulcers
- Your first surgery did not lead to the weight loss you expected
- Your gastric pouch or sleeve has widened over time
Even if you’ve gained weight after a bariatric surgery, revision may not be right for you. Weight regain has many causes, including behavioral and lifestyle factors. Your Rush providers, including gastroenterologists, surgeons, medical weight loss specialists, dietitians and psychologists will work together to develop a plan to help you reach your goals.
Choosing Rush for Endoscopic Bariatric Revision Procedures
- Experienced experts: The Rush bariatric endoscopy team has performed hundreds of bariatric endoscopy procedures. Our physicians are leaders in the field, teaching other physicians across the world how to perform these procedures. Rush experts lead clinical trials and publish research on bariatric endoscopy techniques and outcomes.
- Coordinated care: A team of providers will collaborate to support you before and after surgery. Rush medical weight loss specialists, dietitians and other providers will work together to help you reach your health goals.
- Easy access: The Rush bariatric endoscopy team offers convenient appointments in Chicago, Oak Brook and Munster. If you are considering an endoscopic bariatric revision procedure in Chicago, you can schedule an initial clinic visit and follow up care close to you.
- Among the best in the U.S.: U.S. News & World Report ranks Rush University Medical Center among the best hospitals in the U.S. for gastroenterology and GI surgery.
Frequently Asked Questions
Weight regain after bariatric surgery is common, especially if it has been several years since your surgery. Studies suggest around half of patients regain some weight after bariatric surgery.
An endoscopic revision is performed without incisions. Your doctor will insert a long, thin tube called an endoscope through your mouth and into your stomach. This avoids scar tissue and fibrosis related to prior surgical procedures. Surgical revision will often be performed laparoscopically. Your surgeon will make a few small incisions in your abdomen and use a laparoscope, a small instrument with a camera and light, to operate.
If you’ve had a previous weight loss surgery, you may qualify for bariatric revision. As many as one in five patients who have had weight loss surgery will require a revision. If you have regained weight, or have a complication after surgery, you may be a candidate.
Endoscopic bariatric revision procedures are very safe. No procedure is completely risk free, but given the experience of Rush’s bariatric endoscopy team, the risk of having a serious complication is around 2-3%.
Endoscopic procedures avoid scar tissue and fibrosis that can make surgical revision more challenging. Rush’s multidisciplinary team will work with you to reduce your risk of complications through coaching and communication. Your provider will explain your risks and options to you.
The endoscopic bariatric revision procedures are performed with general anesthesia and take around 45 minutes. If you have an endoscopic revision, you will likely be able to return home the same day.
After your procedure, you will be observed in the recovery area to receive IV hydration. Your care team will make sure you feel comfortable going home.
Abdominal pain and nausea are common for the first two to three days after the procedure but these symptoms can typically be controlled with medications. Most patients return to work three to seven days after the procedure.
Weight loss is not guaranteed after an endoscopic revision, as people regain weight for many reasons. Most patients lose about 10 to 15% of their body weight after an endoscopic bariatric revision procedure. Follow-up with your team to work on dietary, behavioral and lifestyle changes is key to achieving maximum weight loss after the procedure. Your provider will let you know what to expect.
Insurance generally covers revisions to correct complications from a previous surgery. If you are considering an endoscopic revision to address weight regain, coverage will depend on your plan and insurer.
Patients interested in endoscopic bariatric revision procedures can call (312) 942-8651.