BACKGROUND: Super obese patients pose a major health care problem because their obesity is associated with high risks of morbidity and even death. Neither dietary programs nor surgery results in significant or lasting weight loss. Presented here is a new surgical approach, combined with home infusion therapy, that offers effective weight loss with maintenance for 3.5 years. METHODS: Eight super obese patients (252% +/- 19% ideal body weight; 62.7 +/- 5.6 kg/m2 body mass index) underwent near total intestinal bypass anastomosing the proximal 25 to 30 cm of jejunum to the transverse colon. A right atrial catheter was placed for home infusion of necessary fluids, minerals, vitamins, and protein. After desired weight loss was achieved, the jejunocolostomy was taken down with construction of a vertical banded gastroplasty to assist in weight maintenance. RESULTS: An average of 1.5 kg/week was lost. Seven patients lost to an average of 114% +/- 14% ideal body weight (29.0 +/- 2.9 kg/m2 body mass index) after 333 to 556 days. An eighth patient is still losing weight. Weight loss was due mainly to loss of body fat and water. After takedown of the jejunocolostomy and construction of a vertical banded gastroplasty in seven patients, weight loss has been maintained for up to 1218 days. CONCLUSIONS: A new operative approach for super obese patients offers safe and effective weight loss to any desired goal. Subsequent conversion to a vertical banded gastroplasty has so far afforded maintenance of the weight for up to 3.5 years.