Many procedures such as the VBG and AGB have come and nearly disappeared claiming to be superior to the gastric bypass. Even though the sleeve gastrectomy is the most popular procedure worldwide, concerns regarding GERD and Barrett’s esophagus are emerging. Yet the gastric bypass continues to be the operation that all other are compared, not because it is the best, but because it has stood the test of time and other procedures have not endured long enough to demonstrate the favorable outcomes demonstrated in the Swedish Obesity Study or the Utah experience.