INTRODUCTION: We have utilized the Very-Long limb Roux-en-Y Gastric Bypass (VLRYGB) which involves anastomosing the biliopancreatic limb to the ileum 100 cm proximal to the ileocecal valve, in the treatment of super-obese patients. The aim of this study is to evaluate the outcomes of VLRYGB in the treatment of patients whose BMI >60 kg/m². METHODS: Prospectively collected data in all 118 consecutive patients with BMI≥60 Kg/m² who underwent VLRYGB for the treatment of clinically significant obesity from 1998 - 2005 were analyzed. Patients' clinical characteristics, comorbidities, weight loss and complications were reviewed. Follow-up was from clinic visits and phone interviews. Data are mean ± SEM. RESULTS: 83 women and 35 men who underwent VLRYGB (age: 43±1 year; pre-operative BMI: 69±1 kg/m²) had the following major comorbidities: obstructive sleep apnea (64%), hypertension (61%), diabetes (32%) and venous thrombotic events (3%). Mean length of hospital stay was 6±1 days. Complications included: anastomotic leak (4%), gastrointestinal bleeding (3%), venous thrombotic events (3%), myocardial infarction (3%), sepsis (2%), anastomotic ulcer (1%), primary respiratory failure (1%), and renal failure (1%). In-hospital mortality was 3% and was mainly from anastomotic leaks and primary respiratory failure; 30 day mortality was 4%. Within one year post-operatively, 5 patients (4%) developed protein-calorie malnutrition which was reversed with enteral and parenteral protein supplements in 3 patients and by lengthening of the common channel in one patient; one patient who refused intervention died from subsequent liver failure. Overall follow-up was 30±2 months and is complete in 80% of patients. %Excess body weight loss (%EBWL) peaked at 2 years (66±2%, 95% confidence interval (CI): 63-70%) and was sustained at 5 years (66±4%, 95% CI: 58-74%) with 80% of patients achieving >50% EBWL. 95% of patients reported improvement in quality of life, diabetes, hypertension and/or obstructive sleep apnea. CONCLUSION: VLRYGB is effective in inducing durable and sustainable weight loss in super-obese patients that is associated with resolution of obesity-related comorbidities and improvement in quality of life. Close post-operative monitoring may reduce in-hospital mortality. Strict monitoring of nutritional indices is imperative to avoid long-term consequences of protein calorie malnutrition.