Background: The use of the laparoscopic sleeve gastrectomy (LSG), a restrictive operation, in different settings, is presented.Methods: 31 patients underwent LSG in the following groups: 1) 7 patients with very high BMI as a first stage of the duodenal switch (DS); 2) 7 morbidly obese patients with severe medical conditions; 3) 16 obese patients with lower BMI (35-43); and 4) 1 patient converted from a prior gastric banding.Results: 1 patient with BMI 74 died, a 3.