Background and aims: vertical banded gastroplasty (GPV) is the most frequently performed restrictive procedure for morbid obesity, but long term follow-up is almost nonexistent. A poor outcome after GPV and a low quality of life has been reported. The aim of the study was to determine long term outcome after 5 years follow-up. Methods: 225 GPV were performed from 1995 to 2002. Patients were followed every month in the first three months, after 6 and 12 months, and subsequently every year. Results: no mortality was observed. One gastric fistula, treated with medical therapy, was the single related complication observed. Vomiting occurred in 21.2% of patients. After 2 years 74.5% of patients had a BMI < 35, with a decrease of IEW = 50% (IEW%L 54.1 %, 56.4 %, and 57.1 % after 12, 24 and 60 months, respectively). After 5 years, the results were unsatisfactory in 17.1% of patients; 8 patients underwent bariatric re-operation with good results. Conclusions: GPV represents a safe procedure with a low incidence of complications, with poor results in 17.1% of patients. Pre-operative identification of non responders is achievable with “BIB test”. In the responders significant dietary changes are complained.