Background Single-stage laparoscopic sleeve gastrectomy (LSG) may represent an additional surgical option for morbid obesity. Methods We performed a retrospective review of a prospectively maintained database of LSG performed from November 2004 to April 2007 as a one-stage primary restrictive procedure. Results One hundred forty-eight LSGs were performed as primary procedures for weight loss. The mean patient age was 42 years (range, 13-79), mean body mass index of 43.4 kg/m(2) (range, 35-75), mean operative time of 60 min (range, 58-190), and mean blood loss of 60 ml (range, 0-300). One hundred forty-seven procedures (99.3%) were completed laparoscopically, with a mean hospital stay of 2.7 days (range, 2-25). A 2.7% major complication rate was observed with four events in three patients and no deaths. Four patients required readmission; mild dehydration in two, choledocholithiasis in one, and a gastric sleeve stricture in one. Conclusion Laparoscopic SG is a safe one-stage restrictive technique as a primary procedure for weight loss in the morbidly obese with an acceptable operative time, intraoperative blood loss, and perioperative complication rate.