Concomitant hiatal hernia repair during laparoscopic sleeve gastrectomy (LSG) is recommended if it is detected. Intrathoracic sleeve migration (ITSM) is a sliding hiatal hernia that develops after LSG. In this article, we present an early ITSM due to an incomplete repair of a hiatal hernia.An obese patient had hiatal hernia in the preoperative endoscopy. After LSG, the defect was repaired with anterior cruroplasty. Vomiting attacks were observed after the operation. Based on clinical signs and radiological findings, laparoscopic exploration was indicated. During the reoperation, an acute entrapment of the upper portion of the sleeve was observed, which had migrated through the hiatus. This suture was undone. There was no gastric ischemia. No additional hiatal repair was attempted.The operation was sufficient to alleviate the symptoms. The patient was discharged on the second postoperative day uneventfully. Until the most recent follow-up, the patient has progressed with adequate weight loss, without complaints of reflux and without proton pump inhibitors ITSM with incarceration is a complication that can occur after incomplete hiatal repair. Failure to perform hiatal repair with proper technique can be attributed to this complication.

Obesity is one of the most important health problems in developed and developing countries. Morbid obesity is defined as having a body mass index (BMI) of more than 40 kg/m2. Obesity does not only predispose to gastroesophageal reflux, but is also an important independent risk factor for the development of hiatal hernia (HH). There are articles advocating about half of obese patients have a hiatal hernia. Hiatal hernia not only exacerbates reflux symptoms, but may also lead to incomplete removal of the gastric fundus during laparoscopic sleeve gastrectomy (LSG). When hiatal hernias are seen preoperatively or intraoperatively for bariatric surgery, surgical correction should ideally be made with mesh reinforcement to prevent further clinical progression.

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Today, bariatric surgery is the most effective treatment for obesity, and the techniques continue to evolve. Laparoscopic sleeve gastrectomy, which is only one step of biliopancreatic diversion/duodenal switch surgery, has become the most common bariatric procedure due to its efficacy when performed alone. Additionally, the rate of complications has decreased as a result of increased technical experience and the development of stapler technology. The widespread adoption of laparoscopic sleeve gastrectomy is also attributable to its technical simplicity. Although it is assumed to be a simple procedure, mistakes at specific stages significantly increase the risk of complications. We focus on our method in detail, including all operative steps, which we believe is the simplest and most effective technique after performing over 5000 surgeries at our institution. Paying attention to the sleeve size, selecting the appropriate stapler, not narrowing the incisura angularis, resecting the fundus without getting too close to the esophagus, creating a smooth, non-rotating staple line, and suturing the staple line are highlighted.