The number of bariatric operations performed annually in the U.S. for the treatment of severe obesity [body mass index (BMI)≥40 kg/m2] has increased tenfold since the mid 1990s, with approximately 220,000 operations performed in 2009. This article reviews the evolution of laparoscopic bariatric surgery over the last 20 years. The results of the most common procedures are analyzed and current and future trends described.