Gastroparesis is a chornic gastric motility disorder characterized by delayed gastric emptying in the abscence of mechanical obstruction. Given the current epidemic of obesity, the management of gastroparesis in patients with elevated body mass index (BMI) is relevant. In high BMI patients with gastroparesis, sleeve gastrectomy (SG) has been suggested as the preferred surgical therapy. In this chapter, we review the surgical management of gastroparesis with a specific focus on the obese population and sleeve gastrectomy as a treatment modality. Surgical options for non-obese patients include endoscopic per-oral pyloromyotomy, pyloroplasty, gastric electrical stimulator, and enteric feeding tube placement. Surgical options for obese patients include sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB). For obese patients with gastroparesis, SG seems to be a safe and effective initial intervention. RYGB is a second-line option in cases with history of GERD, esophagitis, or Barret’s esophagus.