This intervention create a reduction in gastric capacity but however can also cause significant malabsorption problems. It consists of two surgical acts that can be performed simultaneously or several months apart (12 to 18 months) which has the advantage of reducing the risk of immediate complications especially in cases of massive obesity (BMI – 60 kg/m2).
The first phase, less complex than the second, is to do a sleeve gastrectomy to reduce the volume of the stomach.
The second phase is more complex. It consists of modifying the digestive tract in order to create two circuits; one for the passage of food and the other for the passage of digestive juices, the two circuits joining at the level of terminal small bowel.
To do this the duodenum is divided 3 cm below the pylorus so as to separate the stomach, pylorus and the first centimetres of the duodenum from the rest of the digestive tract and then the small intestine is divided 250 cm from its opening into the colon.
The lower segment of the small bowel is then connected to the small segment of duodenum left attached to the stomach and the upper segment (bilio-pancreatic loop) is reconnected with the small bowel 1 meter from the opening into the colon.