A 37 year old male patient with a history of HBP, T2DM, obstructive sleep apnea syndrome and BMI 58 Kg/m2 undergoes a Lap sleeve gastrectomy as a first stage of treating his MO with the intention of performing a BDP-DS at a second stage. In the following year the patient develops a severe gastroesophageal reflux resistant to medical treatment (EGDT identified a small hiatal hernia), currently with a BMI of 46 Kg/m2. What is the most reasonable option to follow?
