Background <p>Laparoscopic sleeve gastrectomy (LSG) modifies the anatomy, function, and motility of the gastrointestinal tract. Constipation is a prevalent postoperative issue among bariatric surgery patients. This study evaluates the prevalence, predictors, and management of postoperative constipation after LSG.</p> Patients and Methods <p>This multicenter study involved patients with severe obesity who underwent LSG from April 2022 to February 2025. Patients were categorized into two groups: the first group included patients who developed postoperative constipation, while the second group comprised patients with normal bowel movements. The diagnosis of functional constipation was determined according to the Rome IV criteria. The Wexner Constipation Score (WCS) was used to assess postoperative constipation.</p> Results <p>The study included 797 patients (60.6% women and 39.4% men) with a mean age of 34.87&#xa0;years. Postoperative constipation developed in 153 patients (19.2%). The mean WCS was 3.19 ± 3.16. Mild constipation was present in 104 out of 153 patients. Independent risk factors identified for postoperative constipation were female sex, hypothyroidism, preoperative constipation, and gastropexy. However, postoperative fluid consumption of more than 3 L, smoking, and antral preservation were recognized as independent protective factors against postoperative constipation. Postoperative de novo anal fissures secondary to constipation developed in 26/153 patients. Most patients were managed medically. Postoperative grade 2 hemorrhoids developed in 20 patients.</p> Conclusion <p>Post-LSG constipation developed in 153 patients (19.2%). Antral preservation, smoking, and liberal fluid intake were protective factors for minimizing the development of postoperative constipation after LSG. Conservative management remained the primary line of treatment for postoperative constipation.</p>