Background: The use of bariatric surgery in the management of morbid obesity is rapidly increasing. Two of the most frequently performed procedures are laparoscopic sleeve gastrectomy and laparoscopic gastric banding. The objective of this study is to provide a critical appraisal of the most relevant scientific evidence comparing laparoscopic gastric banding versus laparoscopic   sleeve   gastrectomy   in   the   treatment   of   morbidly   obese   patients. Materials and methods: The study was done in Bugshan Hospital, King Abdulaziz University Hospital and Prince Abd El Aziz Bin Mosaed Hospital in Saudi Arabia where 100 patients ( 82 females and 18 males ), with ages ranging between 25 and 46 years were operated upon between May 2005 and November 2007. They were randomly assigned into 2 groups: Group 1 : 52 patients (40 females and 10 males) were assigned to laparoscopic adjustable gastric band. Group 2 : 48 patients (42 females and 8 males) were assigned to laparoscopic sleeve gastrectomy. Results: After 1 year follow up, there was a statistically significant difference between the two groups regarding the mean BMI and the rate of complications (p < 0.05). There was a significant difference between both groups (p < 0.05) regarding pouch that was reported in 4 patients (7.6%) in group 1 and one patient (2.1%) in group 2. Stable line leak was reported in 2 cases (4.2%) and band erosion was reported in 2 cases (3.8%) where re-operation and band removal was done for both of them. After 3 years follow up, there was a statistically significant difference between the 2 groups regarding the mean BMI (p < 0.05). There was no significant difference between the two groups regarding the rate of complications (p>0.05). Four patients (8.3%) in group 2 acquired pouch dilatation. Re-operation and conversion to Roux-en-Y gastric bypass was done to 2 of them. Herniation at the right hypochondrial port site developed in one patient (2.1%) in group 2. Insufficient weight loss was present in 2 patients (3.8%) in group 1 and in 2 patients (4.2%) in group 2 which was not statistically significant (p>0.05). Conclusion: Sleeve gastrectomy is significantly more effective than gastric banding in terms of  late  complications,  late  reoperations,  and  long-term  results  on  weight  loss.