Background: RYGB is a traditional bariatric operation. It entails the formation of a micro-pouch to which a loop of jejunum is to be anastomosed. This which poses a technical challenge. A long slim pouch (EP) is thought to eliminate this difficulty. We aim to test the efficacy, safety and ease of EP as regard weight reduction, resolution, improvement of co-morbidities and effects on patients’ quality of life (QOL). Methods: This randomized work was conducted on 40 individuals ranging in age from 18 to 60 years old, both genders, patients with severe obesity,individuals with body mass index (BMI) ≥ 40 or > 35 kg/m2 with obesity related co-morbidities.Participants had been allocated into two equal groups at random: Group 1: submitted to S LRYGB. Group 2: submitted to EP LRYGB. Results: BMI at 6 and 12 month was significantly lower compared to baseline BMI in group 1 and group 2. HBA1c, participants within the two groups 1 and 2 showed a significant improvement HBA1c at 6 and 12 months when comparing with baseline values. Hypertension (HTN) at 12months remission rate was substantially greater in group 2 contrasted to group 1(P = 0.036).Excess weight loss (EWL %) at 12 months showed a significant increase than EWL % at 6 months in group 1 and group 2. TBWL showed a significant increase at 12 months compared to TBWL % at 6 months. Conclusions: Both surgical S LRYGB and EP LRYGB are effective and safe techniques as they improve weight loss, resolution and co-morbidities and maintain patients’ QOL with minimal complications with no substantial variation among both groups.