Laparoscopic sleeve gastrectomy (LSG) is a novel technique in pediatric bariatric surgery. The patient reported here participated in our pediatric weight management clinic for 2 years. His obesity was complicated by obstructive sleep apnea, acanthosis nigricans, and hypertension. His past medical history included 2 small bowel resections, bilateral nephrectomy and kidney transplantation for multicystic renal dysplasia, and 2 peritoneal dialysis-catheter infections. Gastric banding was contraindicated because of previous foreign body infections and chronic need of immunosuppression and steroids. Roux-en-Y gastric bypass was of higher risk given his previous abdominal operations and the resulting medication absorption issues. He underwent LSG without any complications. Five trocars were utilized and a gastroscope was placed during gastric resection. Presurgical body mass index was 44.8 kg/m. At 18 months follow-up body mass index was 26.5 kg/m. We concur that LSG can be a safe and effective alternative in bariatric surgery in well-selected adolescents.