BPD-TGR appears to be an effective operation with few complications and also a satisfactory correction for failed gastric restrictive procedures, or even a sequential operation in the super-obese.

The SM&M-P procedure confers to this restrictive intervention some characteristics similar to gastric bypass, including rapid transit of the alimentary contents in the prepyloric "mill", scarse reflux into the gastric fundus, possible entero-endocrine effects and loss of interest in food.

Background: The Long Magenstrasse with py-loroplasty as functional Gastric Bypass (briefly LMGBP) procedure for morbid obesity may re- duce the incidence of side effects associated with gastric restrictive and malabsorptive sur- gery, particularly on quality of life and long-term nutritional insufficiency. In follow-up to pre- liminary findings in 34 patients, we report the results of an additional 274 LMGBPs performed over the past 3 years. Methods: Between October 2003 and 2009, 308 patients were treated with the LMGBP. 149 patients underwent open procedures; 74, hand-assisted laparoscopic surgery (HALS); and 85 were operated laparo-scopically. 17% had ≥ 125 mg/dl glycemia, 43% sleep apnea, 38% hyperlipidemia, 12% hyperuricemia, and 58% arterial hypertension under treatment. Results: The mean BMI of 256 pre-operatively normoglycemic patients at 1 year was 29 (range 26-31); 27 (25-30) in 45 patients at 3 years; and 27.5 (26-30) in 12 patients at 5 years. Mean BMI of 53 preoperatively hyperglycemic patients (≥ 125 mg/dl) at 1 year (21 patients) was 32 (29-34), and at 3 years (9 patients), 32.5 (30- 33). 15 patients with preoperative type 2 diabetes under oral treatment required no therapy 3-6 months after surgery. Patients reported considerable appetite reduction with rapid satiety but maintained good nutrition with no supplementation. There was no mortality. Conclusions: Safe and effective sustained weight loss, positive metabolic changes, and appetite diminution with rapid satiety were seen after LMGBP

Background: The considerable increase in Obesity and especially the increase in super obese patients (Body Mass Index-BMI ≥ 50 Kg/m 2) who require surgery lead doctors to search for surgery techniques which give good results in terms of a consistent and stable weight loss associated with low morbidity and good quality of life. The Long Magenstrasse (LM) intervention, born from combining two properly modified surgical procedures (Selective Vagotomy with pyloric divulsion and Mangestrasse & Mill by Johnston) seems to have these characteristics according to our experience after operating on 660 patients. Methods: From October 2003 to October 2008 we treated 186 patients with LM. One hundred and sixty-two patients were regularly present to the annual follow-up, but 24 patients didn't turn up, therefore, they were contacted by phone. On average, surgery lasted approximately 80 minutes (range: 50-90 minutes). Thirty patients were super obese with an average BMI of 57.4 Kg/m 2 ; 156 patients were grade II and III obese with an average BMI of 40.7 Kg/m 2. Results: The average BMI of the 30 super obese patients decreased from 57.4 Kg/m 2 to 35.9 Kg/m 2 one year after surgery, to 35.6, 5 years after surgery and it has remained stable until now. In the 156 patients suffering from II and III grade obesity, the average BMI decreased from 40.7 Kg/m 2 to 27.8 Kg/m 2 one year after surgery and it has remained stable until now. Out of all super obese diabetic patients, only one has partially maintained his/her therapy. Patients have reported a decreased appetite since the very first days of post-operative period with an early sense of satiety which is unchanged until today. Conclusions: A consistent and stable weight loss over 5 years after surgery even in Super Obese patients, a decrease in appetite with an early sense of satiety, a re-equilibrium of the metabolic syndrome in particular of Diabetes Mellitus, allow to classify LM among those surgical treatments with a mixed mechanism of action: both restrictive and functional, in particular, entero-hormonal and gastric neurosecretory.