Purpose Metabolic bariatric surgery in adolescents is an evolving field, and data is limited in Australia. Surgery in this age group has special safety, social and ethical considerations. The impact of MBS on psychiatric, mental health and psychosocial wellbeing is poorly understood. We review the patient demographics, mental health conditions, weight outcomes, complications and follow-up of a cohort of adolescents who underwent laparoscopic sleeve gastrectomy (SG) by a single surgeon in a large volume clinic with an established adolescent multidisciplinary team program receiving patients from across Australia and New Zealand. Methods A prospective bariatric database was retrospectively analysed to review the adolescents aged 13-19 who underwent a primary SG from December 2011 to December 2024. Patients who were a minimum of six months post-surgery were included. Results 63 patients aged 13-19 years old underwent primary SG. Median pre-operative weight and body mass index (BMI) was 123 kg and 42.1 kg/m2. Pre-operatively, 26 adolescents reported a Psychiatric and/or mental health disorder, seven reported suicidal ideation or self-harm history and six reported experiencing severe weight- bullying. At three months, six months, twelve months and two years after SG, median BMI decreased to 33.6, 30.6, 27.5 and 28.1 kg/m2 respectively. Follow-up rates progressively decreased and was 42% at two years. There was no mortality and one staple line leak. Conclusion SG is a safe and promising option for the treatment of adolescents living with obesity in the short to medium-term. The high prevalence of mental health disorders and poor follow-up are major concerns. Long-term data with better follow-up is required in Australia.