Background and Aims Laparoscopic sleeve gastrectomy (LSG) is presently one of the most common bariatric operations. Its weight-loss effect in simple obese patients has reached consensus among surgeons, but its effect in super obese (SO) patients has not been reported on a large scale. This was conducted to retrospectively investigate the weight-loss effect and perioperative safety of LSG for super-obese patients with a BMI greater than 50 kg/m².Methods Super obese patients who received LSG in the Department of General Surgery of Beijing Tiantan Hospital Affiliated to Capital Medical University from March 2017 to June 2022 were selected. The variables such as operative time, bleeding volume, and complication were recorded, the surgical safety of LSG in super obese patients was observed, and the improvements in body weight, BMI, excess weight loss (%EWL), fasting blood glucose, liver and kidney function, blood lipid, uric acid and comorbidities after LSG were analyzed.Results A total of 39 super obese patients were included, including 23 males and 16 females, with an average age of (31.15±8.37) years, an average preoperative weight of (159.97±19.97) kg, and an average BMI of (54.46±3.89) kg/m². In all patients, the routine preoperative examination, abdominal ultrasound, vascular ultrasound, gastroscopy, echocardiography, blood gas analysis, and other tests were completed, and preoperative evaluation through multidisciplinary consultation was made. All patients underwent a four-port laparoscopic operation without conversion to open surgery. The average operative time was (63.00±12.30) min, and the intraoperative blood loss was (23.00±4.30) mL. Cirrhosis was found in one patient during the operation, without hypersplenism and portal hypertension; there was no severe liver dysfunction, no abdominal bleeding, secondary operation, pulmonary infection, lower extremity venous thrombosis, and perioperative death after the procedure., From the first month after the operation, the weight and BMI of the patients began to decrease significantly. The %EWL at the 1st, 3rd, 6th, 12th, 24th, and 36th months after the operation was 17.69%, 38.84%, 54.21%, 62.09%, 61.12%, and 57.00%, respectively; from 3 months after the operation, alanine aminotransferase and aspartate aminotransferase decreased significantly compared with those before operation (all P<0.05); blood lipids were improved after operation, uric acid significantly reduced at 12 months after operation (P<0.05); there was no significant change of creatinine and urea nitrogen before and after the operation (both P>0.05); in 9 patients with type 2 diabetes, the glycosylated hemoglobin markedly decreased after the operation, and one patient still needed oral hypoglycemic drugs six months after operation; one year after the operation, the liver and kidney functions and blood lipids of all patients returned to normal, and only 3 of the 12 hypertensive patients still needed antihypertensive drugs.Conclusion LSG has a high safety in super obese patients and has a good effect on weight loss and comorbidity control. It can be the first weight loss surgery choice for such patients.