Minimally invasive treatment for decreasing restriction after Roux-Y gastric bypass with extended anastomosis

Endoscopic anastomosis tightening (TORe, transoral outlet reduction) for the treatment of secondary weight gain or late dumping after gastric bypass surgery

The Roux-en-Y gastric bypass (RYGB) is one of the most frequently performed bariatric operations in Europe. Unfortunately, many patients regain weight in the longer term after RYGB. This (secondary) weight gain is multifactorial and may be caused by anatomical changes such as dilatation of the (initially narrow) gastrojejunal anastomosis.

Anatomy: Situation after bariatric treatment with a Roux-Y gastric bypass.

Patients can be offered surgical revision of the gastrojejunal anastomosis, but this is often associated with higher risks than primary bariatric surgery. Transoral outlet reduction after Roux-en-Y gastric bypass is a procedure to treat complications that can occur after gastric bypass surgery. In a Roux-en-Y gastric bypass, the stomach is reduced in size and the small intestine is rerouted to limit food intake and reduce nutrient absorption. Outlet reduction refers to narrowing or reducing the outlet between the stomach and the small intestine to control the flow of food and solve certain problems.

This therapeutic option is often used to treat various problems:

Dumping syndrome: early dumping or late dumping
uncontrolled weight gain after gastric bypass surgery
Stagnation of weight loss after gastric bypass surgery

Strategic Center for Obesity Professional Education (SCOPE) certification from the World Obesity Federation.

Association of Bariatric Endoscopy (ABE): ABE members offer the latest endoscopic bariatric procedures to improve the health and well-being of patients with obesity. They promote the safe and effective integration of endoscopic bariatric therapies into practice by providing cutting-edge information, education and support for patients. for practice. The Association of Bariatric Endoscopy (ABE) is a member group of the American Society for Gastrointestinal Endoscopy (ASGE.org).

There are various approaches to transoral outlet reduction. In contrast to surgical revision procedures, the best method is minimally invasive endoscopic procedures (TORe). These involve the use of special endoscopes and instruments that are inserted through the mouth to reach the outlet of the stomach and perform a narrowing or reduction without the need for incisional surgery:

BARS system: endoscopic treatment of weight gain or dumping syndrome following gastric bypass
Apollo suture system (Overstitch): Endoscopic treatment of weight gain or dumping syndrome after gastric bypass

Endoscopy offers many advantages, including faster recovery, lower risks and less post-operative pain compared to conventional surgery or a residual foreign body (MiniMizer Gastric Ring). In TORe, endoscopically placed transmural sutures are used to reduce the gastrojejunal anastomosis, which has become wide over the years, to around 1 cm in diameter, allowing the restriction to be restored. Another method is the BARS procedure using clip retraction.

It is important to emphasize that endoscopic transoral outlet reduction (TORe) after Roux-en-Y gastric bypass is a specialized treatment and should only be performed by specialized gastroenterologists. Patients should be fully informed of the risks, benefits and success rates and undergo a thorough assessment to determine if they are suitable for this type of treatment.

With many years of experience in interdisciplinary management at the bariatric center in pre- and post-surgical patient care and minimally invasive complication management, Vivomed is the right address for competent treatment.

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