A 60-year-old woman, with a medical history of Sleeve Gastrectomy, and an initial BMI of 53 and weight of 127 Kg. After three years of follow up the patient has regained weight with a current BMI of 38.7. The response of her comorbidities was moderate with DMII requiring oral antidiabetic treatment and high blood pressure, requiring just one medicament for correct control. Additionally, the patient has osteopenia, detected at the preoperative evaluation for a second-step obesity surgery, and bilateral inguinal hernias, with reducible small bowel on them were found in the physical examination which restrict her physical activity and exercise. Which procedure would you offer to this patient?
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