No. TORe is an endoscopic procedure done through the mouth. There are no incisions.

Is TORe done as an outpatient?

Yes. TORe is almost always outpatient at INOVA Fair Oaks Hospital, and most patients go home the same day.

How much weight will I lose after TORe?

In published long-term data, patients lost an average of about 8 to 9 percent of total body weight, maintained at five years. Combining TORe with nutrition support or a GLP-1 medication can improve results.

Can TORe be repeated?

Yes. If the outlet stretches again, TORe can be repeated, and it does not prevent a surgical revision later.

Will TORe help dumping syndrome?

Often, yes. Slowing the passage of food from the pouch can reduce dumping symptoms after meals.

Do I need to travel to Northern Virginia more than once?

Usually not much. The first consultation can be done by telehealth, and the procedure is same-day.

TORe (Transoral Outlet Reduction) in Northern Virginia

An incisionless, outpatient fix for weight regain after gastric bypass

Accuracy of the medical content was verified by Dr. Matthew Fitzer, M.D., FACS, FASMBS, a board-certified bariatric surgeon. (He authored most of it.) Read Dr. Fitzer's professional bio

Weight regain years after a gastric bypass is common, and it is not a personal failure. One frequent cause is mechanical: the connection between the stomach pouch and the small intestine (the outlet) gradually stretches. A wider outlet lets food pass through faster, so you feel full later and hungry sooner. TORe tightens that outlet from the inside, using an endoscope passed through the mouth, with no incisions.

Far Away? Make a Telehealth Appointment

How TORe works

Under general anesthesia, Dr. Fitzer passes an endoscope through the mouth into the gastric pouch. The edge of the stretched outlet is prepared so the tissue will heal together, then an endoscopic suturing device places stitches that cinch the opening down to a smaller diameter. The pouch itself can be reinforced with additional stitches when it has also stretched. The procedure typically takes about an hour, and there are no incisions or scars.

Who is a candidate for TORe?

TORe is designed for people who:

Had a Roux-en-Y gastric bypass and have regained weight, or did not lose as much as expected
Have a dilated outlet confirmed on upper endoscopy
Notice they can eat larger portions than they could early after surgery, or feel hungry soon after eating
Have dumping symptoms after meals (TORe can improve these as well)

Weight regain has more than one cause. If the outlet is not stretched, or the main problem is a large pouch or a short limb, a surgical revision or distalization may be the better tool. Dr. Fitzer reviews your endoscopy and upper GI study to recommend the right approach.

What to expect on the day

TORe is an outpatient procedure at INOVA Fair Oaks Hospital in Fairfax, and almost all patients go home the same day. Plan on a sore throat and some upper-abdominal discomfort or nausea for a day or two. You will need someone to drive you home.

Recovery and diet after TORe

Because the stitches need time to heal, you will follow a staged diet: liquids first, then soft foods, then a gradual return to regular textures over several weeks. We give you a written plan before the procedure. Many patients return to desk work within a few days. Follow-up with our team at the Herndon office, or by telehealth, keeps you on track.

Results you can expect

TORe is not designed to repeat the weight loss of the original bypass. Its job is to stop regain and restore the sense of fullness. In the largest long-term study, patients lost an average of about 8 to 9 percent of their total body weight, and that loss held at five years. Results are best when TORe is combined with nutrition support, and a randomized trial found that adding a GLP-1 medication right after TORe led to more weight loss than TORe alone.

Risks

TORe is considered low risk compared with surgical revision. The most common side effects are temporary nausea, abdominal pain, and sore throat. Less common problems include bleeding, or the outlet narrowing too much and needing to be stretched with an endoscope. Stitches can loosen over time, and some patients choose a repeat TORe later.

TORe vs. surgical revision

TORe: no incisions, outpatient, home the same day, quick recovery, modest and durable weight loss
Surgical pouch revision or distalization: more weight loss potential, one night in the hospital, longer recovery, higher risk

For many patients TORe is a sensible first step, and it does not rule out surgery later.

Insurance and self-pay

Insurance coverage for TORe varies by plan. TORe is also available self-pay. Our office can check your benefits before you schedule.

TORe in Northern Virginia

TORe is performed at INOVA Fair Oaks Hospital in Fairfax, with consultations and follow-up at our office at 171 Elden Street, Suite 3B, Herndon. Because it is a same-day procedure, it is practical even if you live a few hours away. Patients from Richmond, Fredericksburg, Charlottesville and Hampton Roads can start with a telehealth consultation and make a single trip for the procedure.

TORe: frequently asked questions

Is TORe surgery?: No. TORe is an endoscopic procedure done through the mouth. There are no incisions.
Is TORe done as an outpatient?: Yes. TORe is almost always outpatient at INOVA Fair Oaks Hospital, and most patients go home the same day.
How much weight will I lose after TORe?: In published long-term data, patients lost an average of about 8 to 9 percent of total body weight, maintained at five years. Combining TORe with nutrition support or a GLP-1 medication can improve results.
Can TORe be repeated?: Yes. If the outlet stretches again, TORe can be repeated, and it does not prevent a surgical revision later.
Will TORe help dumping syndrome?: Often, yes. Slowing the passage of food from the pouch can reduce dumping symptoms after meals.
Do I need to travel to Northern Virginia more than once?: Usually not much. The first consultation can be done by telehealth, and the procedure is same-day.

Take the next step

Request a consultation Medical Weight Loss Bariatric Surgery

Medical references

Jirapinyo P, Kumar N, AlSamman MA, Thompson CC. Five-year outcomes of transoral outlet reduction for the treatment of weight regain after Roux-en-Y gastric bypass. Gastrointest Endosc. 2020;91(5):1067-1073. https://doi.org/10.1016/j.gie.2019.11.044
Vargas EJ, Bazerbachi F, Rizk M, et al. Transoral outlet reduction with full thickness endoscopic suturing for weight regain after gastric bypass: a large multicenter international experience and meta-analysis. Surg Endosc. 2018;32(1):252-259. https://doi.org/10.1007/s00464-017-5671-1
Lahooti A, Hoff AC, Critelli B, et al. A randomized, double-blind, two-way cross-over study to evaluate the efficacy of liraglutide treatment in patients undergoing transoral outlet reduction endoscopy for weight regain post Roux-en-Y gastric bypass. Obes Surg. 2025;35(3):775-783. https://doi.org/10.1007/s11695-025-07671-5
Hakiza L, Sartoretto A, Burgmann K, et al. Transoral outlet reduction (TORe) for the treatment of weight regain and dumping syndrome after Roux-en-Y gastric bypass. Medicina (Kaunas). 2023;59(1):125. https://doi.org/10.3390/medicina59010125

Last updated: October 1, 2026