Proximal Roux-en Y gastric bypass (RYGB) representing the most frequently performed bariatric procedure yields a weight loss failure rate of around 20 %. In order to reduce failure rates, we established a novel distal RYGB variant characterized by a very long alimentary (Roux) limb and a short common channel. Up to 5 years, follow-up data (complication rates, weight loss, nutritional/metabolic changes) of the first 355 patients (mean ± SD preoperative age, 41.4 ± 10.8 years; BMI, 48.5 ± 11.5 kg/m(2)) who underwent the novel Distal Very Long Roux-en Y Gastric Bypass (DVLRYGB) were analysed. Overall follow-up rate was 98.9 %, mean follow-up time 1.6 ± 1.4 years. Limb lengths were as follows: common channel 76 ± 7 cm, biliopancreatic limb 79 ± 14 cm, and alimentary (Roux) limb 604 ± 99 cm. The operation was performed laparoscopically in 95.2 % of the cases. Thirty-day mortality was zero; major and minor complication rate was 4.5 % and 10.4 %, respectively. Average excess weight loss (EWL) was >74 % 3, 4, and 5 years after the operation and failure rate defined by an EWL < 50 % remained < 6 %. Annually blood measurements revealed a relatively low incidence rate of severe nutritional deficiencies, but mild anaemia and hypoproteinemia were frequently observed. Laparoscopic revision with a proximalization of the lower anastomosis was required in 4 (1.1 %) patients. Data indicate that our DVLRYGB leads to excellent weight loss results. Furthermore, within the setting of a structured multidisciplinary follow-up program, the incidence of severe malnutrition states was relatively low.