Bariatric surgery, although not a cure for obesity, can help selected extremely obese adolescents achieve significant weight loss and improvement of obesity-related comorbidities, in conjunction with continued dietary and behavioral interventions. This article summarizes the current guidelines for selection of adolescent candidates for bariatric surgery and discusses the types of bariatric procedures presently available for this age group. Data on the complications and outcomes of bariatric surgery in this special population are reviewed.