Michael Long, MD, in Melbourne, Australia, changed the outlet of horizontal gastroplasty from greater to lesser curvature in 1977. By 1981 he had also changed the slope of the partition from one that slanted slightly upward on the greater curvature to one that was vertical and ended (or began) at the esophagogastric angle of His. In 1987 Long and Lindsey20 added 2 braided-suture ligatures (Ethibond; Ethicon, Somerville, NJ) for stabilization of the outlet. Long presented this experience at a meeting in Genoa, Italy, in the fall of 1980. One of Long's surgical residents, Andrew Jamieson, MD, reduced the pouch size and added a third outlet suture, which lengthened the stabilized area to 22 mm.21 Jamieson has continued to use this operation and has experience with more than 3000 patients. The operation needs adaptation to the laparoscopic approach if it is to be widely adopted. Because there is no circular stapler window, the stapling (in continuity) is from the angle of His and parallel to the lesser curvature. This requires a small diameter stapler that can be maneuvered safely into position laparoscopically. Changing the staple line from horizontal to vertical made the outlet a part of the pouch instead of a defect in the partition. This eliminated the unzipping of the staple line, which started at the stoma in horizontal gastroplasty.