Background: Sleeve Gastrectomy (SG) has gained acceptance as the first part of a 2-stage procedure in individuals with super morbid obesity (BMI>55), and has increasingly been suggested as a primary operation for morbid obesity. Methods: 84 patients underwent SG from Feb. 2001 to May 2002. Forty six patients had a follow up > 1 year (average of 34 months). 32 patients had a BMI <= 55 and 14 patients had a BMI > 55. All patients were followed until a 2nd-stage procedure occurred or for the length of their follow up. Success was defined as an EBWL of >45%. Patients with BMI >55 were not subjected to the success/fail demark as 2nd stage intervention usually precluded this analysis. The SG procedure was performed using the lesser curve gastric tube fashioned over a 60F bougie. Results: Of the 46 patients, 70% were females, average age was 40.5 years and average BMI was 51.9. There were no deaths, no leaks, and no re-operations for complications. Patients with BMI<=55, achieved success 66% of the time (21/32) and these patients achieved an average EBWL of 71% (95% CI = 65% to 78%). As compared to 11 failures (34%) in this group with an average EBWL of 23% (95% CI = 14% to 32%). This remarkable difference reached statistical significance (p <.0001). Conclusion: These data show that over a 3 year follow up, SG performed as a primary procedure in MO patients with a BMI <= 55, is successful in fully two-thirds of patients and achieves an EBWL of 71%. These results are comparable to gastric bypass historical data. Although, longer follow-up and a larger cohort is required to validate these results and to assess the validity and efficacy of SG for patients with a BMI > 55, our data suggest that sleeve gastrectomy is a viable and reasonable alternative to gastric bypass.