Fig. 1
Gastric sleeve
Home the same day, for most
Transoral Outlet Reduction (TORe) in Toronto
A minimally invasive endoscopic procedure for selected people who have regained weight after a gastric bypass. Stitches placed from the inside make the stretched outlet smaller again, with no incisions.
- For
- People who had a Roux-en-Y gastric bypass
- How
- Endoscopic, through the mouth
- Incisions
- None
- Time
- About 45 to 90 minutes
- Home
- The same day, for most people
Fig. 1
A simplified diagram for education, not to scale.
A minimally invasive revision procedure after gastric bypass
What Is Transoral Outlet Reduction?
Transoral outlet reduction is an endoscopic revision procedure for people who have had a Roux-en-Y gastric bypass.
In short
TORe narrows the stretched outlet of a gastric bypass with stitches placed through the mouth. It aims to restore the feeling of fullness and support weight management. It is not surgery on the belly, and nothing is removed.
During a gastric bypass, a small stomach pouch is joined to the small intestine through an opening called the gastrojejunal anastomosis, or gastric outlet. In some people, this opening slowly stretches over time.
When the outlet is wider, food can leave the pouch more quickly. This can reduce fullness after eating and may lead to larger portions, more hunger or weight regain.
TORe makes the enlarged outlet smaller with stitches placed from the inside. It is done through the mouth, with no incisions on the belly, and no stomach tissue is removed.
- Through the mouthA flexible endoscope reaches the pouch.
- Stitches insidePlaced around the outlet, then tightened.
- Nothing removedNo incisions and no tissue taken out.
At 360 Sleeve in North York, Toronto, TORe is offered in a private clinic as part of our bariatric revision care. A consultation reviews your first procedure, your health today and whether TORe may suit you.
TORe, step by step
Scroll to follow the procedure in 3D: the bypass as it is today, the stretched outlet, the endoscope and the ring of stitches. Scroll back to see any step again.
Fig. 2, Revision and TORe - 01
After a gastric bypass
A bypass leaves a small pouch joined directly to the intestine. The old stomach stays in place, unused.
- 02
The outlet can stretch
Over the years the connection, the outlet, can widen. Food then passes quickly and fullness fades.
- 03
Through the mouth
TORe is endoscopic: a flexible scope passes through the mouth into the pouch. No incisions.
- 04
Stitches around the outlet
Stitches are placed in a ring around the outlet from the inside.
- 05
The outlet is narrowed
Tightening the ring brings the outlet back to a smaller size, so food leaves the pouch more slowly.
- 06
A fuller feeling again
The scope is removed. Most people go home the same day.
A simplified 3D illustration for education, built from anatomical proportions. Your surgeon explains what applies to you.
Who Is a Candidate for TORe?
TORe may be considered for selected people who had a gastric bypass and now have weight regain or less restriction. Tick what applies to you.
Benefits of TORe
What TORe may offer the right person. Your doctor explains which of these apply to you.
- 01
No external incisions
TORe is done through the mouth with an endoscope, so there are no cuts on the belly and no scars on the skin.
- 02
Less invasive than surgical revision
TORe does not reopen or rebuild the bypass. For the right person, it may mean a shorter recovery than revision surgery.
- 03
May restore restriction
A smaller outlet may help you feel full sooner and stay satisfied longer after eating.
- 04
May support renewed weight loss
TORe may help stop ongoing regain and support more weight loss, together with nutrition, activity, behavioural support and follow-up.
- 05
May help with dumping syndrome
Because it slows how fast food moves into the intestine, TORe may be considered for some people with dumping syndrome. A medical assessment decides if it applies to you.
What Results Can I Expect After TORe?
Results vary. They depend on how much the outlet had stretched, how much weight came back, eating habits, activity, health and taking part in follow-up care.
The aim of TORe is often to stop further regain, restore restriction and support a renewed weight-management plan. People who stay involved with dietary guidance, regular activity, behavioural support and follow-up generally have the best chance of long-term success.
Results vary. No specific amount of weight loss can be guaranteed.
Average total body weight loss after TORe
A published five-year study of people who had TORe after a gastric bypass
- 1 year
- 3 years
- 5 years
See the numbers as a table
| Time after TORe | Average total body weight loss | People with data |
|---|---|---|
| 1 year | 8.5% | 276 |
| 3 years | 6.9% | 211 |
| 5 years | 8.8% | 102 |
Recovery After TORe
Because TORe is endoscopic and needs no incisions on the belly, recovery is usually quicker than after surgical revision of a gastric bypass.
- The same day
Home, for most people
You rest with a nurse while the anesthesia wears off. An overnight stay may be advised if it is medically needed.
- The first days
Liquids and light walking
A liquid diet first. Some people have nausea, bloating, cramping or belly discomfort for a few days.
- Within a few days
Light daily activities
Most people are back to light everyday activities within a few days.
- About 3 to 7 days
Back to work
Many people return to non-strenuous work in about 3 to 7 days, depending on their job.
- The weeks after
Food in stages, exercise slowly
Puréed, then soft, then regular foods, as your care team advises. Exercise comes back gradually, once your team says it is safe.
Your own plan
Your exact diet, activity limits and follow-up are given to you by your care team. Following them is important while the treated area heals.
How eating in stages works Risks to know about
Like any procedure, TORe has risks. Most side effects are short-lived, such as a sore throat, nausea or belly discomfort. Less often, there can be bleeding, an ulcer near the outlet, or an outlet that becomes too narrow and makes eating hard, which may need treatment. Your doctor goes through the risks that apply to you.
This page is general information, not medical advice.
Performs TORe at 360 Sleeve
Dr. Gary Gamme
MD, MPH, FRCSC, FACS, DABOM
A bariatric and advanced endoscopic surgeon. He trained in advanced endoscopy at the University of Miami and in bariatric surgery at the University of Ottawa, and holds a Master of Public Health from Harvard. He also performs ESG at 360 Sleeve.
What 360 Sleeve Offers
- Bariatric and endoscopic surgeonsTORe is performed by Dr. Gary Gamme, a bariatric and endoscopic surgeon.
- Support before and afterA nurse, a dietitian and a patient care coordinator who know your history.
- A plan made for youBuilt around your first surgery, your health and your goals.
- Long-term follow-upCheck-ins after your procedure, and help if things change.
- Financing optionsBeautifi or Medicard, 6 months to 6 years, for qualified patients.
Whether you are considering TORe, ESG, a gastric sleeve or SADI-S, our team helps you choose a plan that fits your health and goals.
360 SleeveTORe, all-in price
- Your procedureDr. Gary Gamme and the endoscopy teamIncluded
- AnesthesiaWith monitoring throughoutIncluded
- The facilityProcedure room, recovery and nursingIncluded
- TaxesIncluded in the priceIncluded
Total, taxes included$14,500
How Much Does TORe Cost?
The cost of transoral outlet reduction at 360 Sleeve in Toronto is $14,500, taxes included. Because TORe is done in a private clinic, it is not covered by OHIP. Financing options may be available for qualified patients.
$467a month at an example 9.9% APR
Financing through Beautifi or Medicard, 6 months to 6 years, no prepayment fees. The lender sets your rate after approval.
At your consultation, our team reviews the full cost, payment and financing options, the expected recovery and whether TORe may be right for you.
Have Questions About TORe?
The questions people ask most before choosing TORe. Dr. Gamme answers them for your own history at your consultation. This page is general information, not medical advice.
Still wondering? , or ask the assistant in the corner.
-
01Is TORe a weight-loss surgery?
TORe is an endoscopic bariatric procedure, not traditional abdominal surgery. It is done through the mouth with an endoscope, so there are no cuts on the skin.
-
02Is TORe only for gastric bypass patients?
TORe is mainly for selected people who had a Roux-en-Y gastric bypass and whose outlet has become enlarged. It is not normally used to revise a gastric sleeve or a gastric band.
-
03Does TORe make my stomach pouch smaller?
TORe mainly makes the opening between the stomach pouch and the small intestine smaller. In some cases, extra stitches may also be placed in the pouch, depending on your anatomy and your doctor’s plan.
-
04How much weight can I lose after TORe?
Weight loss varies. In a published five-year study, average total body weight loss was about 8.8% at five years, but results differ from person to person. No specific amount of weight loss can be guaranteed.
-
05Will TORe restore my gastric bypass?
TORe does not repeat or rebuild the whole gastric bypass. It aims to restore some of its restriction by making an enlarged outlet smaller.
-
06Is TORe permanent?
The stitches are meant to keep the outlet smaller for the long term, but the body can change over time. Some people see the outlet widen again or regain weight, and may need more treatment.
-
07Can TORe be repeated?
In selected cases, another endoscopic treatment may be considered if the outlet widens again or more treatment is needed. This depends on your anatomy, your medical history and how you responded the first time.
-
08Does TORe leave scars?
No. There are no scars on the skin, because the procedure is done through the mouth.
-
09How long does the procedure take?
TORe often takes about 45 to 90 minutes. The time depends on your anatomy and the techniques needed.
-
10Will I stay overnight?
Most people go home the same day. An overnight stay may be recommended if it is medically needed.
-
11When can I return to work?
Many people return to non-strenuous work in about 3 to 7 days. Your doctor gives you advice based on your recovery and your job.
-
12What can I eat after TORe?
You start with a liquid diet, then move to puréed, soft and regular foods in stages. Your care team gives you a structured plan to follow.
-
13Can TORe treat dumping syndrome?
TORe may help some people with dumping syndrome after a gastric bypass, because it slows how fast food moves into the small intestine. A medical assessment is needed to know if it is right for your symptoms.
-
14What happens if TORe is not suitable for me?
Your bariatric team may talk with you about other options, such as nutrition care, anti-obesity medication, behavioural support, another endoscopic procedure or surgical revision.
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15Who performs TORe at 360 Sleeve?
Dr. Gary Gamme, MD, MPH, FRCSC, FACS, DABOM, a bariatric and advanced endoscopic surgeon.
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16How much does TORe cost?
TORe at 360 Sleeve is $14,500, taxes included. It is done in a private clinic, so OHIP does not cover it. Financing may be available for qualified patients.
Your first step is a conversation
A free consultation, in person in North York or online. Meet the team, ask anything and leave with a clear plan and price.
(416) 360-7360 sleeve@clinic360.com 1131A Leslie St #300, Toronto, ON M3C 3L8