Inclusion Criteria:  BMI of > 40 kg/m 2 or > 35 kg/m2 with comorbidities e.g. hypertension and type 2 DM. All patients failed in supervised conservative management for obesity for at least 2 years.  Exclusion Criteria:  BMI > 60 previous bariatric surgery symptomatic reflux oesophagitis disease, gastric pathology (tumor, active peptic ulcer) Significant psychological disorder, active alcohol or substance abuse severe eating disorders (bulimia) severe systemic disease making anesthesia or surgery prohibitively risky (American Society of Anesthesiologists (ASA) class IV