TORe Offers A Second Chance For Bariatric Patients

By Mohd Afiq Zulkifli

KUALA LUMPUR, June 20 (Bernama) -- Regaining weight after bariatric surgery does not necessarily indicate that a patient has failed. Instead, it is one of the long-term challenges that may arise after patients reach their lowest weight.

Upper GI, Bariatric and Metabolic Surgery Unit specialist at the Hospital Canselor Tuanku Muhriz Universiti Kebangsaan Malaysia (HCTM UKM), Dr Loo Guo Hou, said a slight weight regain following bariatric surgery is common and expected. However, clinical attention is required when the increase becomes significant.

Although there is no standard definition for post-bariatric weight regain, he said most studies show that about one in five patients, or between 20 and 24 per cent, experience weight gain exceeding 15 per cent within five years after undergoing gastric bypass surgery or sleeve gastrectomy.

“Nevertheless, long-term follow-up over 12 years shows that around 93 per cent of patients still maintain at least a 10 per cent reduction in body weight, while only one per cent return completely to their original weight.

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“Bariatric surgery remains highly effective, and weight regain is a manageable challenge rather than a sign that the surgery has failed,” he told Bernama.

Dr Loo said the emotional burden faced by patients is often greater than the physical one, as many seek treatment feeling disappointed, ashamed and self-critical, believing they have squandered the benefits of a major surgical procedure.

He explained that weight regain is often caused by anatomical and physiological changes in the body, including the stretching of the stomach outlet, rather than simply a lack of discipline or personal weakness.

This is among the issues addressed through the Transoral Outlet Reduction (TORe) procedure, an endoscopic technique introduced at HCTM UKM as a follow-up treatment option for selected bariatric patients.

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Dr Loo said TORe is performed through the mouth using a specialised suturing device to tighten the enlarged stomach outlet, eliminating the need for external incisions and preventing new scars.

He described the procedure as a second chance for patients, as it helps restore the function of the stomach outlet that regulates the passage of food, although it should not be viewed as a shortcut to weight loss.

“TORe does not melt fat or cause weight loss on its own. Instead, it restores satiety and control, allowing healthy eating habits and exercise to become effective again.

“It is like tightening a loose belt. It helps you eat less, but you still need to eat properly,” he said.

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Dr Loo stressed that TORe is not a first-line weight loss treatment and is not suitable for everyone. Rather, it is intended for patients who have previously undergone bariatric surgery, particularly gastric bypass surgery, and who experience weight regain due to an enlarged stomach outlet or dumping syndrome.

He explained that dumping syndrome occurs when food moves too quickly into the intestine, causing symptoms such as abdominal cramps, heart palpitations, sweating, dizziness and diarrhoea after meals.

According to Dr Loo, the most important aspect following TORe is for patients to regard the procedure as a fresh start rather than a definitive solution. This involves developing structured eating habits, including eating slowly, prioritising protein intake, controlling portion sizes and avoiding high-calorie sugary drinks.

He added that consistent physical activity, emotional support and regular follow-up with the bariatric care team, nutritionists and psychologists, when necessary, are equally important in ensuring long-term weight maintenance.

“Sustained weight loss ultimately depends on long-term lifestyle changes. TORe simply gives patients a better opportunity and environment to succeed,” he said.

--BERNAMA