This procedure has two critical steps: first, performing sleeve gastrectomy, and second, connecting the first part of the Bowel, which is the duodenum, to the small Bowel further downstream (usually leaving only 300 cm of the small Bowel as a common channel for absorption). This procedure induces excellent weight loss, but it comes with a high risk of Chronic diarrhoea and malnutrition. Patients do require intensive surveillance and supplementation, as with other bypasses.