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Background: laparoscopic sleeve gasterectomy (LSG) is no longer a simple weight loss procedure but can favor morphological, functional, and biochemical changes on different body tissues and systems.Very few studies deal with effect of weight reduction after bariatric surgery on epicardial fat as a newly considered cardio-metabolic indicator. Methods: case series study applied on 70 morbidly obese patients who underwent laparoscopic sleeve gasterectomy (LSG) at Cairo university hospitals, these patients were investigated by CT volumetry for assessment of size of epicardial fat preoperatively and 3 months postoperatively to measure the effect of LSG in reduction of size of epicardial fat. Results: 70 patients were included in the study.The pre-operative BMI ranging from 40 kg/m2 to 62 kg/m2 with a mean of 45.6 kg/m2 and the pre-operative epicardial fat volume ranging from 123 to 264 mm3 with a mean of 174.6 mm3. After three months follow up, the BMI was decreased to a mean 35.5 kg/m2 (ranging from 30 kg/m2 to 45.5 kg/m2).With a change around 10 kg/m2 (ranging from 18.5 kg/m2 to 4.5 kg/m2). (Std: 2.3831, P < 0.000) while the mean change in epicardial fat volume after three months was 26.9 mm3 (ranging from 95 mm3 to 2 mm3), the three months post-operative mean epicardial fat volume was147.8 mm3( ranging from 110 mm3 to 245 mm3) ( std : 18.325, P < 0.000). Conclusion: from this study we concluded that laparoscopic sleeve gasterectomy (LSG) reduces epicardial fat volume which increases the cardiovascular competence. [ABSTRACT FROM AUTHOR]