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Bariatric surgery is technically complex. It is important to refine existing methods and explore new techniques to improve the outcomes of patients. We discuss the characteristics and applications of the precise laparoscopic Roux-en-Y gastric bypass (PLRYGB) in clinical practice.We retrospectively analyzed the clinical records of obese patients who underwent laparoscopic Roux-en-Y gastric bypass between 2009 and 2012, and compared surgical data, postoperative recovery, weight loss, and complications of patients who underwent PLRYGB with those who underwent conventional laparoscopic Roux-en-Y gastric bypass (CLRYGB) surgery.Of 211 patients, 89 underwent CLRYGB and 122 PLRYGB. Although the operating time for PLRYGB was significantly longer than CLRYGB (149±23 min vs. 138±23 min, P<0.05), length of hospital stay was shorter in those undergoing the precise technique (4.2±1.1 d for PLRYGB and 7.7±1.5 d for CLRYGB, P<0.05), and the percentage of excess weight lost 18 months after surgery was greater (78.4±8.2% for PLRYGB and 64.5±8.4% for CLRYGB, P=0.000). Five patients (5.6%) who underwent conventional surgery experienced postoperative complications, including 1 anastomotic leak and 1 internal hernia; 1 patient required redo surgery, and 2 corrective surgery. There were no postoperative complications in the PLRYGB group.PLRYGB is safe and feasible. The precise approach did not substantially increase operating time but decreased duration of hospital stay and the incidence of postoperative complications, whereas weight loss outcomes were significantly better.