But for some people, things can change again years later.

They may notice that the weight starts creeping back. They don’t feel as full as they once did. Meals that used to satisfy them suddenly seem too small. Some patients also begin experiencing unpleasant symptoms of dumping syndrome.

It can be confusing and upsetting. Many people wonder if they have somehow caused the problem themselves.

Often, that isn’t the case at all.

In many situations, the reason is anatomical. The body changes over time, even after successful surgery.

To help explain what happens and what options may exist, we spoke with Mr Achille Mastrosimone, Consultant General and Upper GI Surgeon, who specialises in advanced endoscopic treatments for bariatric patients.

Interview with Mr Achille Mastrosimone

What is TORe?

Mr Mastrosimone: TORe stands for Transoral Outlet Reduction. It is an incisionless endoscopic procedure designed for patients who previously had a Roux-en-Y gastric bypass and later develop problems such as dumping syndrome or weight regain.

The procedure is performed using a flexible endoscope that is passed through the mouth, so there are no external cuts or abdominal incisions.

After gastric bypass surgery, the stomach pouch connects to the small intestine through a small opening called the gastrojejunal anastomosis, often referred to as the outlet.

Over time this outlet can stretch. When that happens, food moves through the stomach more quickly and the feeling of fullness becomes weaker.

During TORe, we place sutures around this outlet using a specialised endoscopic suturing device. This reduces its size again, which helps slow gastric emptying and restore restriction.

In some cases, if the gastric pouch has also stretched, we can reduce its size endoscopically at the same time.

Why does gastric bypass sometimes stop working as well over time?

Mr Mastrosimone: Weight regain after gastric bypass is usually multifactorial. There are often several contributing factors, including physiological adaptations, behavioural changes, and, in some patients, significant anatomical changes.

In some patients, over time, the outlet between the stomach pouch and the small intestine can widen, and the pouch itself may stretch slightly. When that happens, the restrictive effect of the operation becomes less effective.

As a result, food can pass through the pouch more quickly, patients may feel hungry again sooner after eating, and portion sizes may gradually increase. This can contribute to weight regain.

It is important to stress that these changes can be mechanical and are not simply a question of behaviour. They may occur even when a patient is doing everything right.

Is dumping syndrome one of the main reasons people consider TORe?

Mr Mastrosimone: Yes, very often. In fact, in my experience the strongest indication for TORe is dumping syndrome.

Dumping syndrome occurs when food moves too quickly from the stomach pouch into the small intestine. Patients may experience symptoms such as sweating, dizziness, nausea, palpitations, diarrhoea or low blood sugar after eating.

By reducing the diameter of the outlet, TORe slows gastric emptying. This can significantly improve these symptoms and help patients feel more comfortable after meals.

How do you decide if someone is suitable for the procedure?

Mr Mastrosimone:  The first step is a careful assessment of the anatomy. Before recommending TORe, I perform an OGD, also known as a gastroscopy. This is a procedure that uses a small camera to look inside the stomach. It allows me to measure the opening and assess the size and length of the stomach pouch.

This evaluation is essential because TORe works best when the outlet is enlarged. Patients with an outlet diameter of 2.5 cm or more tend to benefit the most, and results are often even better when the outlet is greater than 3 cm.

If the pouch is also significantly enlarged, we may perform an endoscopic pouch revision at the same time as the outlet reduction.

This ensures that the procedure is tailored to each patient’s anatomy.

What happens during the procedure itself?

Mr Mastrosimone: The procedure takes place in theatre under general anaesthetic, which means the patient will be asleep throughout. The anaesthetist will give the anaesthetic and monitor the patient carefully.

We start by performing an OGD (gastroscopy) to reassess the size and length of the stomach pouch. If appropriate to proceed, we then treat the inner lining of the join between the stomach and bowel (the anastomosis) using a special heat probe called APC.

 After this, a specialised stitching device attached to the endoscope is used to place stitches around the outlet. These stitches make the opening smaller, which helps food stay in the stomach pouch for longer and move through more slowly.

The procedure usually takes about 60 to 90 minutes.

As there are no cuts on the outside of the body, recovery is usually quicker than with revisional surgery.

How does TORe compare with revisional bariatric surgery?

Mr Mastrosimone: Revisional surgery can be quite complex. Surgeons often have to deal with scar tissue and may need to reconstruct parts of the bypass.

TORe is much less invasive because it’s done endoscopically. There are no abdominal incisions, and the recovery is usually faster. The risk of complications is also generally lower.

For some patients, TORe can delay or even avoid the need for major revisional surgery.

What should patients expect after the procedure?

Mr Mastrosimone: Most people recover well after the procedure and only have mild symptoms. It is quite common to have a sore throat or some temporary bloating. Mild abdominal discomfort can also occur, but this is usually well controlled with common painkillers.

Many patients go home the same day or after a short overnight stay.

Normal activities can usually be resumed within a few days.

As with any bariatric treatment, the best results happen when the procedure is combined with ongoing dietary and multidisciplinary support.

Understanding the Next Step

Weight regain after gastric bypass can feel discouraging, but it is not unusual. Obesity is a chronic condition, and treatment sometimes needs to evolve over time.

For patients who develop dumping syndrome, loss of restriction or anatomical changes after gastric bypass, TORe may offer a minimally invasive way to address the underlying issue.

At Blackrock WeightCare, careful assessment is always the first step. A detailed consultation and endoscopic evaluation help determine whether TORe is the right option for each individual patient.

If you have had gastric bypass surgery and are experiencing weight regain or dumping syndrome, you can make an enquiry here or call 01 255 2479 to arrange an assessment with the team at Blackrock WeightCare.

Your Health. We Care.

The post TORe after Gastric Bypass: A Conversation about Dumping Syndrome and Weight Regain appeared first on Blackrock WeightCare.

Experience matters most in high-BMI surgery

High-BMI bariatric surgery is not simply a “larger version” of standard weight loss surgery. It demands deep clinical expertise, careful patient selection, advanced surgical skills, and the ability to manage complex metabolic conditions. At Blackrock WeightCare, high-BMI patients are treated every day, not occasionally. This depth of experience allows the team to anticipate challenges, reduce risk, and tailor each surgical plan to the individual.

Under the care of Mr William Robb, one of Europe’s highest-volume robotic bariatric surgeon, patients benefit from a level of expertise that is especially important in complex and high-BMI cases. His experience includes performing bariatric and revision procedures on patients who have often been declined elsewhere due to risk or complexity.

Robotic bariatric surgery for precision and safety

Robotic-assisted bariatric surgery plays a crucial role in managing complex cases. For patients with higher BMI, robotic surgery allows for enhanced precision, improved visualisation, and finer control during technically demanding procedures. This can translate into safer surgery, reduced complication rates, and improved outcomes, particularly in operations such as SADI-S and revision surgeries.

At Blackrock WeightCare, robotic surgery is not an occasional offering. It is a core part of the practice, especially for patients who require advanced surgical approaches due to body size, previous surgeries, or metabolic disease.

A centre experienced in SADI-S and complex procedures

SADI-S is increasingly recognised as one of the most effective procedures for patients with very high BMI, severe insulin resistance, or inadequate results from previous surgery. Blackrock WeightCare is currently the only centre in Ireland for primary SADI-S, with over 60 of these procedures performed, giving patients confidence that they are being treated by a team familiar with the nuances of this operation.

For high-BMI patients, SADI-S offers a more durable solution than sleeve gastrectomy alone, particularly when long-term weight loss and metabolic improvement are the primary goals. Patients with a BMI of over 50 are often only offered a sleeve operation as that is all that the surgeon they are attending is comfortable performing – this does not make it the right operation for them.

Multidisciplinary care, not just surgery

Complex bariatric surgery does not begin or end in the operating theatre. High-BMI patients often require coordinated care across multiple specialties. Blackrock WeightCare is built around a strong multidisciplinary team that includes bariatric nurses, specialist dietitians, endocrinologists, physiotherapists, and psychologists.

This team approach ensures that patients are prepared physically and mentally before surgery, supported closely in the early recovery phase, and guided for years afterwards as their bodies adapt to significant weight loss and metabolic change.

Structured aftercare that supports long-term success

One of the key reasons Blackrock WeightCare is trusted for high-BMI surgery is its structured Two-Year Aftercare Program. This programme is designed to support patients through every stage of recovery and long-term weight maintenance. It includes regular medical reviews, nutritional guidance, metabolic monitoring, and access to the clinical team when questions or concerns arise.

For SADI-S patients in particular, Blackrock WeightCare also provides access to a dedicated patient support community, allowing individuals to share experiences, practical advice, and encouragement with others on a similar journey. This added layer of support can make a significant difference, especially for those who have struggled with weight for many years.

A centre patients trust when others say no

Many patients who come to Blackrock WeightCare have been told elsewhere that their BMI is too high or that surgery would be too risky. Rather than applying blanket limits, the team focuses on careful assessment, evidence-based decision making, and individualised planning. This approach has helped many patients safely access surgery that has transformed their health, mobility, and quality of life.

A safe and trusted choice for high-BMI patients

Choosing bariatric surgery is a major decision, and choosing the right centre matters just as much. For patients with complex needs or a high BMI, Blackrock WeightCare offers the experience, advanced robotic surgery, and comprehensive aftercare needed to support lasting change. Our team understands obesity as a medical condition, not a personal failure, and treats every patient with respect, care, and honesty.

If you have been struggling for years and feel you need more than a standard solution, Blackrock WeightCare is a place to begin again, safely and with confidence.

To explore your options or check your eligibility, call us on 01 255 2479 or fill the form here. A simple conversation can bring clarity, and we would be glad to guide you from there.

Your Health. We Care.

The post Why Blackrock WeightCare is a Trusted Centre for Complex and High-BMI Robotic Bariatric Surgery appeared first on Blackrock WeightCare.

When someone searches online and sees a lower price quoted abroad, it can feel like the obvious choice. Surgery overseas is often presented as quicker, cheaper, and straightforward. For patients who have already spent years paying for diets, gyms, medications, and private appointments, saving money feels sensible.

What many patients only realise later is that the upfront price is just one small part of the overall picture.

The True Reason Many Patients Travel Abroad

The most common reason patients choose to have bariatric surgery abroad is not convenience or preference. It is cost.

Many people do not realise that bariatric surgery is often covered by private health insurance in Ireland. Instead of checking their cover, they assume surgery here is unaffordable and begin comparing prices overseas.

Patients frequently say they wish they had known this sooner. By the time they discover that insurance may have covered surgery locally, they have already travelled, paid, and returned home without long-term support in place.

The Cost That Is Not Listed Online

While surgery abroad may appear cheaper on paper, patients often say they did not fully account for the additional costs.

Travel expenses, accommodation, time off work, and repeat trips for follow-up all add up. More importantly, when complications arise after returning home, further medical costs may fall entirely on the patient.

Revision surgery, additional scans, blood tests, or nutritional treatment are rarely included in the original price. Over time, many patients find that what seemed cheaper initially becomes far more expensive in the long run.

Surgery Does Not End When You Leave the Hospital

One of the biggest surprises for patients is how much care is needed after surgery.

Bariatric surgery changes how your body absorbs nutrients, processes food, and regulates hormones. Regular follow-up, blood tests, and dietary support are essential to avoid deficiencies and long-term complications.

When surgery is performed abroad, aftercare is often limited. Patients may receive a short follow-up window and then are expected to manage on their own once they return home.

Many patients say they assumed their GP would take over care seamlessly. In reality, GPs may not have access to full surgical details or be familiar with specific procedures performed overseas.

The Difficulty of Finding Support Back Home

Patients often say they did not anticipate how difficult it could be to find ongoing bariatric support in Ireland after surgery abroad.

Access to dietitians, nurse specialists, and bariatric surgeons is not guaranteed once the original clinic is no longer involved. This can leave patients feeling uncertain, especially when symptoms such as reflux, vomiting, fatigue, or weight regain begin to appear.

This lack of continuity is one of the most common reasons patients later seek revision surgery.

When Weight Loss Is Not What Was Expected

Some patients also wish they had known that not every bariatric procedure suits every person.

Factors such as starting BMI, diabetes, reflux, and metabolic health all influence which surgery is most appropriate. When procedures are chosen based on speed or cost rather than individual assessment, long-term results may fall short of expectations.

Weight regain, severe reflux, or nutritional problems can develop months or even years later, often leading patients to seek further surgery.

Revision Surgery Is Not a Small Step

Many patients say they did not realise how complex revision surgery can be.

Revision procedures carry higher risks and require specialist experience. While they can be life-changing when needed, most patients wish they had avoided needing further surgery altogether.

Looking back, patients often say they would have chosen differently if they had understood the long-term implications of their first decision.

The Emotional Impact Is Often Overlooked

Weight loss surgery brings emotional changes as well as physical ones.

Patients speak openly about struggling with body image, food relationships, and expectations after surgery. Without structured support, these challenges can feel overwhelming.

Those who had access to ongoing care often say the emotional support made as much difference as the surgery itself.

What Patients Say They Would Do Differently

When reflecting on their experience, many patients say they would have:

• Checked their Irish private medical insurance cover first
• Asked who would support them long-term
• Considered aftercare as seriously as the operation
• Chosen a centre closer to home with ongoing access to care

These reflections are not regrets, but lessons learned through experience.

A More Informed First Step

Bariatric surgery can be life-changing, but the journey does not end in the operating theatre. Many patients later reflect that the real work begins afterwards. Before focusing solely on cost, it is worth considering what support will be available in the years ahead, how any complications would be managed, and whether insurance cover closer to home could make a difference.

Taking the time to explore all of your options, including what may already be covered in Ireland, can help ensure that surgery leads not just to weight loss, but to lasting health, confidence, and peace of mind. The team at Blackrock WeightCare is here to guide you through those conversations and help you understand what is right for you.

If you have private medical insurance, you can click here to check your cover and our team will guide you through the process. Alternatively, you are very welcome to call us directly on 01 255 2479 to discuss your options.

Your Health. We Care.

The post What Patients Wish They Had Known Before Travelling for Bariatric Surgery appeared first on Blackrock WeightCare.

This is not about where a surgery is performed, but how the entire journey is managed, especially what happens before and after the operation.

Bariatric Surgery is Not a One-Day Event

One of the most common misunderstandings is that bariatric surgery is complete once the operation itself is over. In reality, surgery is just one part of a much longer process.

Successful long-term weight loss depends on:

• Careful pre-operative assessment
  
• The right procedure for the individual
  
• Ongoing medical follow-up
  
• Dietetic and nutritional support
  
• Early identification of complications

When surgery is carried out abroad, this continuity of care can be difficult to maintain once the patient returns home.

Limited Aftercare and Follow-Up

Aftercare is one of the biggest reasons revision surgery becomes necessary.

Many overseas clinics provide only short-term follow-up, often limited to a few weeks. Once the patient returns to Ireland, access to the original surgical team is no longer straightforward. If symptoms develop months or years later, patients may not know who to contact, or they may delay seeking help altogether.

Without regular follow-up:

• Nutritional deficiencies may go unnoticed
  
• Weight regain may not be addressed early
  
• Reflux, vomiting, or intolerance to food may worsen
  
• Anatomical changes may be missed

By the time help is sought locally, revision surgery may be the safest option.

One-Size-Fits-All Procedures

Another reason revision surgery is more common is that not every bariatric procedure suits every patient.

Factors such as:

• Starting BMI
  
• Metabolic conditions like diabetes
  
• Reflux disease
  
• Eating patterns
  
• Hormonal health
  all influence which operation is most appropriate.

In some cases abroad, procedures are chosen based on speed, availability, or cost rather than individual complexity. A surgery that initially leads to weight loss may later prove insufficient, resulting in weight regain or unresolved health problems that require revision.

Higher Risk of Nutritional and Anatomical Issues

Revision surgery is often required due to complications that develop over time, including:

• Severe reflux after certain procedures
  
• Narrowing or twisting of the stomach
  
• Malabsorption leading to deficiencies
  
• Poor weight loss or significant regain

When ongoing blood tests, dietetic reviews, and clinical monitoring are not built into the original care plan, these issues may progress quietly until surgical correction becomes necessary.

Challenges Transferring Care Back to Ireland

Irish bariatric centres frequently see patients who have had surgery abroad and now need support. While care is always patient-focused, it can be challenging to take over management when:

• Operative reports are incomplete or unavailable
  
• Details of surgical technique are unclear
  
• There is no shared aftercare pathway

This lack of information can delay treatment and sometimes limits non-surgical options, making revision surgery the most effective solution.

Revision Surgery is More Complex Than Primary Surgery

It is important to understand that revision bariatric surgery is more complex than a first operation. It carries higher risks and requires significant expertise.

This is why preventing the need for revision, through careful planning and long-term follow-up from the start, is always the preferred approach.

Making an Informed Choice

Travelling abroad for bariatric surgery may seem appealing at first glance, but it is essential to look beyond the initial procedure. The true measure of success is not just weight loss in the first year, but health, safety, and quality of life for decades to come.

Before deciding where to have surgery, patients should ask:

• Who will support me long-term?
  
• How will complications be managed?
  
• What happens if my needs change?
  
• Is revision surgery part of a considered plan or a future risk?

Revision surgery is more common after bariatric procedures performed abroad not because patients make poor choices, but because long-term care is often fragmented. Bariatric surgery works best when it is delivered as part of a structured, well-supported journey, with access to the same clinical team over time.

For anyone considering bariatric surgery, taking the time to understand the importance of local expertise, continuity of care, and comprehensive aftercare can make all the difference to long-term success.

If you are weighing up your options or seeking guidance after previous surgery, a conversation with an experienced bariatric team at Blackrock WeightCare can help you understand what is right for you, now and in the future.

You are very welcome to call us on 01 255 2479, or complete the enquiry form here and a member of our team will get back to you shortly

Your Health. We Care.

The post Why Revision Surgery is More Common After Bariatric Procedures Abroad appeared first on Blackrock WeightCare.

Bariatric surgery has proven to be a life-changing solution for individuals battling obesity, offering significant weight loss and relief from obesity-related health conditions. However, not every bariatric procedure achieves the desired outcomes for every patient. For individuals who have undergone bariatric surgery but struggle with insufficient weight loss, weight regain, or unresolved health conditions, Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy (SADI-S) offers a second chance.

This innovative surgical approach is gaining recognition as an effective option for patients seeking to revise or enhance their bariatric journey.

Understanding SADI-S Surgery

SADI-S combines elements of the gastric sleeve and traditional duodenal switch procedures. It involves:

1. Sleeve Gastrectomy: The first step reduces the stomach’s size by approximately 80%, limiting food intake and reducing hunger hormones like ghrelin.
2. Single Anastomosis Duodeno-Ileal Bypass: The second step bypasses a portion of the small intestine, reducing calorie and fat absorption. Unlike the traditional duodenal switch, SADI-S involves a single connection (anastomosis) between the stomach and the small intestine, simplifying the procedure and lowering the risk of complications and malabsorption.

SADI-S is considered less invasive than the traditional duodenal switch while retaining its effectiveness, making it an ideal option for revisional surgeries.

How SADI-S Can Help as a Revisional Procedure

For patients whose initial bariatric surgery has not delivered the desired outcomes, SADI-S offers several advantages:

1. Enhanced Weight Loss

By bypassing a larger portion of the small intestine, SADI-S significantly reduces calorie and fat absorption, leading to additional weight loss. This is particularly beneficial for patients experiencing weight regain after their initial procedure.

2. Improved Metabolic Outcomes

SADI-S has shown remarkable results in improving or resolving co-morbidities such as:

• Type 2 diabetes
• Hypertension
• Sleep apnea
• Dyslipidemia (abnormal cholesterol levels)

The metabolic benefits stem from changes in gut hormones and bile acid metabolism due to the intestinal bypass.

3. Simplified Surgical Technique

Unlike the traditional duodenal switch, SADI-S involves only one intestinal connection, reducing surgical complexity and associated risks.

4. Customizable Approach

Surgeons can tailor the length of the bypassed small intestine to the patient’s specific needs, balancing weight loss outcomes with the risk of nutritional deficiencies.

5. Addressing Complications from Prior Surgeries

SADI-S can correct complications such as:

• Anatomical issues with prior surgeries
• Stretching of the stomach pouch
• Stretching of a sleeve and inadequate weight loss after sleeve

Who Is a Candidate for SADI-S Surgery?

Patients considering SADI-S as a revisional procedure typically fall into the following categories:

• Individuals with failed gastric sleeve or gastric bypass surgeries.
• Those experiencing significant weight regain after an initial bariatric procedure.
• Patients with unresolved or worsening co-morbidities post-surgery.
• Those who are committed to long-term lifestyle and dietary changes required for success.

Every patient requires a thorough evaluation, including medical history, nutritional assessment, and imaging studies, to determine if SADI-S is the right choice.

Benefits of SADI-S as a Revisional Surgery

SADI-S is highly regarded for its balance of effectiveness and safety. Some of its key benefits include:

• Significant and sustained weight loss
• Better management of co-morbidities
• Reduced risk of complications compared to traditional duodenal switch
• Improved quality of life, including enhanced mobility, reduced joint pain, and better mental health

What to Expect: Recovery and Aftercare

Recovering from SADI-S as a revisional surgery may require additional care due to previous surgical history. Here’s what patients can expect:

1. Hospital Stay: Typically 2–3 days for laparoscopic procedures.
2. Post-Surgery Diet: A gradual transition from liquids to soft foods, eventually reintroducing solids over 6–8 weeks.
3. Regular Monitoring: Follow-up appointments to monitor weight loss, nutritional status, and overall health.
4. Nutritional Supplements: Long-term supplementation of fat soluble vitamins and minerals, such as Vitamin A,D,E and K, Vitamin B12, calcium, and iron, is essential to prevent deficiencies.
5. Lifestyle Modifications: Patients must adhere to a balanced diet and incorporate physical activity for optimal outcomes.

Why Choose Blackrock WeightCare for SADI-S Surgery?

At Blackrock WeightCare, we specialize in offering advanced bariatric solutions, including SADI-S as a revisional procedure. Here’s what sets us apart:

• Experienced Bariatric Surgeons: With extensive expertise in revisional surgeries, our team ensures the highest standard of care.
• Comprehensive Aftercare Program: Our support extends beyond surgery, including personalized dietary guidance, psychological support, and regular follow-ups.
• State-of-the-Art Facilities: Equipped with advanced technology like the da Vinci Xi robotic system for precision and safety.

Taking the Next Step

A failed bariatric procedure can be disheartening, but it doesn’t have to be the end of your weight loss journey. SADI-S surgery offers hope and a second chance to achieve your health goals. By addressing the unique challenges faced by revisional patients, SADI-S provides an effective pathway to improved health and well-being.

If you’re considering SADI-S or want to learn more about revisional bariatric options, contact Blackrock WeightCare today. Our team is here to guide you every step of the way, helping you make an informed decision for a healthier, happier future.

Your Health. We Care. 

The post SADI-S Surgery for Patients with Failed Bariatric Procedures: A Second Chance appeared first on Blackrock WeightCare.