Background: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) has been shown to be safe and effective. Little information is available about the subgroup of patients with BMI ≥60. The goal of this study was to evaluate the feasibility and safety of LRYGBP for patients with BMI ≥60. Methods: The study consisted of the first 300 attempted LRYGBPs performed by one surgeon (HJS). This population was analyzed as 2 groups of patients: those with BMI P=0.04). Major complications occurred more commonly in the BMI ≥60 group (10% vs 6%) but this difference was not significant. The types of complications differed between the 2 groups, with infectious complications and gastrointestinal leak occurring more frequently in the heavier group. The mortality rate was higher in the heavier group (5% vs 0.4%, P=0.055). Conclusion: LRYGBP is feasible for patients with BMI ≥60. Our data suggest that these patients are at a higher risk for GI leak, postoperative infection, and death.