Sleeve gastrectomy is one of the most popular bariatric surgical procedure in the USA, currently being performed almost 3 times more than Roux-en-Y gastric bypass. After 5 years, weight regain is possible. Also, sleeve gastrectomy followed by duodenal switch has been initially described as a two-stages procedure for super-obese patients. Here, we described the technical steps, including dissection of the lower stomach, inferior pyloric vessels and the first part of the duodenum, with complete duodenal transection. The upper anastomosis, a duodeno-ileostomy, end to side, antecolic is performed with the ileal loop with hand-sewn techniques. The second anastomosis, an ileo-ileostomy side to side follows, with both linear and hand sewn techniques. Importantly, to avoid internal hernias, both mesenteric defects are closed on the left side, the ileo-ileostomy mesenteric defect, and the Petersen's defect, between the transverse mesocolon and the ileum mesentery. We describe this in a 40 y.o. patient who had an initial sleeve gastrectomy when the BMI was 54.7 kg/m² and was successfully lowered to 24.3 kg/m². After 6 years, the weight had progressively increased to a BMI of 39.5 kg/m² and an hypoabsorptive surgery was offered, since she was super-obese initially. After nearly 6 months, BMI had decreased to 29.3 kg/m². The second stage is ideal for these patients because the duodenum has not been operated before, with excellent blood supply, and offer a tension free anastomosis. This hypoabsorptive surgery is also ideal when the gastric tube of the sleeve is not tremendously enlarged, when re-sleeve is not possible.