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Background: Laparoscopic Gastric Sleeve Resection (LGSR) and Laparoscopic Roux Y Gastric Bypass (LRYGB) are frequent used methods in metabolic surgery.LRYGB is more complex and for this reason more demanding surgical procedure with better results on co-morbidities and on weight loss comparing with LGSR.The long term results of the two interventions including quality of life (QL), weight loss and resolution of the co-morbidities (diabetes Ⅱ, hypertension, gastro-esophageal reflux, degenerative joint disease, sleep apnoe) will be discussed.The operative technique and our practice related to the indication of the different metabolic surgical procedures will be presented too.Method: A match pair analysis of 47 LGSR (using a bougie of 14 mm) and 47 LRYGB patients (150 em nutritive loop and 100 cm bilio-pancreatic loop) was performed applying the database of 352 patients undergoing bariatric surgery in the last five years in our department.Results: By means of two standard QL questionnaires (MooreheadArdelt Ⅱ and SF 36) the gastric bypass patients achieved slightly higher score than the patients atter gastric sleeve resection without reaching statistical significance.The extra weight loss was clearly higher after LRYGB (88%) than after LGSR (70%) resulting a p value of 0,0001.Relating to the resolution of diabetes type Ⅱ, hypertension and gastroesophageal reflux significantly better results were found in the patient group of gastric bypass.94% of the patients after LRYGB and 90 % of the patient after LGSR were satisfied with the achieved postoperative result.Conclusion: The patients have signed a high level of satisfaction after both surgical procedures.LRYGB seems to be associated with a trend toward a better quality of life without reaching statistical significance and has a pronounced loss of weight and more remarkable positive effects on the co-morbidities comparing with the gastric sleeve resection.For this reason LRYGB is our first choice in metabolic surgery.LGSR is applied by us first of all for patient with reduced general condition and with BMI>60.Technically it is easier to perform, not so demanding for the patients and the postoperative results are acceptable.In case of insufficient loss of weight later-with lower BMI and with lower operative risk-it can be converted to LRYGB.