TOR-E (Transoral Outlet Reduction) -- Help me understand!

Hello!

New member, but not new bariatric pt. Original RNY in 2004. Original loss -160#. Currently down only -70# from original highest weight. Have spent the last 1.5 years on medication assisted weight loss protocols. -10#.

I am researching the TOR-e. NOT interested in full revision as I can not accept the risks of full surgery - original RNY landed me in the ICU for 4 days. Endoscopic/outpatient or nothing.

Has anyone had a TOR-e? I keep hearing about an Apollo Overstich, but from what I read that is changing the size of the pouch not the outlet, and this is outlet reduction rather than pouch. What is the difference with all these various endogastric procedures? I know many of them are not very popular. Has anyone here had a TOR-e?

The research I am looking at is:

• Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis. https://www.ncbi.nlm.nih.gov/pubmed/28664438
  
  
• Five Year Outcomes following Transoral Outlet Reduction (TORe) Show Effective and Durable Treatment of Weight Regain after ROUX-EN-Y Gastric Bypass https://www.gastrojournal.org/article/S0016-5085(17)34356-1/abstract
  
  
• Endoscopic Suturing for Transoral Outlet Reduction Increases Weight Loss After Roux-en-Y Gastric Bypass Surgery https://www.gastrojournal.org/article/S0016-5085(13)00493-9/ fulltext

All of these procedures, TOR, Apollo, ROSE, are designed to narrow an enlarged stoma, not the pouch size. They are all pretty similar, and have different names because the surgeons who developed them gave slightly different techniques.

I can only go by the shared experiences of those on OH, as I haven't had it done myself. Weight loss hasn't been great from everything I've read. There has been initial loss, which can be accounted for by pre and post op diets and recovery. But long term it hasn't seemed to help much.

As I've had a diagnosis of lipedema in the 15 years since my RNY procedure, I think it's really unwise to expect it would even be possible to achieve or maintain more than about 25# of loss from any kind of revision. So that's really my goal here.

Wow I wish I had some knowledge to pass along to you. It looks like you've already done a goodly amount on your own though and that is always important.

Those procedures only affect the stoma. They posit that by tightening that up, folks will have more restriction for awhile I guess and be able to jump start their weight loss.

This is only my own anecdotal evidence, but I've yet to see anyone have this type of procedure and lose more than 20-30ish pounds. That doesn't preclude your trying it of course. If your stoma has actually stretched and you've confirmed that via endoscopy, there is a chance of your losing some weight once it's fixed.

I wouldn't personally undergo any procedure though until I had reports from the docs confirming the stretched stoma. Even those who undergo full on revisions are still going to come to a point where there is nothing more to be done surgically. These big surgeries give us a chance at a level playing field but don't kid yourself. It's always going to come back to calories in vs calories out. Once that malabsorption is gone from a virgin surgery, it's not likely to come back with any significance. Even with tightening up the stoma.

Good luck, I hope whatever you choose works for you. This stuff is hard. But we can do hard things. Take care, and keep us posted. You also might try posting this on one of the general forums. They get more traffic.

almost forgot

Consult with doc; I am not a good candidate anyways as my outlet is apparently, after 15 years, not stretched. So.... moot point.