Background: Laparoscopic gastric bypass is the 'gold standard' for treatment of morbidly obese patients in many centres. There is debate regarding the optimal length for small bowel limbs. This study aimed to determine whether the proximal or distal approach is better.Methods: Twenty-five patients undergoing primary distal gastric bypass in 2000-2002 were randomly matched for age, sex and preoperative body mass index (BMI) with 25 patients having a primary proximal bypass. All distal operations were performed laparoscopically; one proximal procedure was converted to open surgery. Results: Mean operating time was 170 min for proximal and 242 min for distal bypasses (P = 0·004); median hospital stay was similar in the two groups. There were no deaths and the overall complication rate was similar, as was weight loss at 4 years: BMI decreased from 45·9 to 31·7 kg/m 2 for the proximal and from 45·8 to 33·1 kg/m 2 for the distal approach. Co-morbidities decreased after surgery in both groups; the prevalence of diabetes, arterial hypertension and dyslipidaemia at all time points was similar in the two groups.Conclusion: Proximal and distal laparoscopic gastric bypass operations are feasible and safe, with no differences in weight loss or reduction of co-morbidity in unselected morbidly obese patients.

SummaryObesity is a chronic disease requiring long-term care. The purpose of the current study was the evaluation of a web-based intervention (WBI), subsequent to an initial face to face life style treatment. In a randomized trial, 84 women received an introduction phase (4 months) and a training phase (2 months) where one group was trained in using WBI whereas the other arm received a printed manual (PMI). During the self-monitoring phase (6 months) participants either used the WBI or the PMI for follow-up support. Anthropometric parameters could be significantly reduced and self-efficacy was significantly increased in the first 6 months. At 12 months, values of self-efficacy of the WBI were not superior compared to results of the PMI; however, feedback on acceptability of the intervention did show higher ratings of the WBI and also facilitated contact with the program supervisor. No significant differences regarding the engagement in follow-up tools could be found between the intervention groups. Subgroup analysis indicated a positive effect of involvement in both forms of self-monitoring aftercare.