Sleeve gastrectomy is one of the most commonly performed procedure for treatment of morbid obesity. The surgery evolved from two step procedure of biliopancreatic bypass/duodenal switch. The procedure is safe and associated with symptoms of gastroesophageal reflux, food intolerance and vomiting. These symptoms are attributed to the improper sleeve position and deformity, due to the loss of natural attachments of the stomach. We here by present a case with morbid obesity in which we did sleeve gastrectomy with sleeve fixation. Post operatively patient had benefit from complications which are previously attributed due to sleeve rotation .Our patient was 51 year old male with the history of morbid obesity since 10 years with the BMI of 44.20 . Patient has the history of Smoking, hypertension, Obstructive sleep apnea, Diabetes Mellitus with renal failure. After preoperative workup and anaesthetic check up patient was taken up for surgery and sleeve gastrectomy procedure with sleeve fixation was done. Gastrograffin study done on post op day 1 was normal and Patient was started orally liquids on day 1 and discharged on day 2. On follow up patient was doing fine, lost 36 kg weight in 8 months. There was no problem of gastroesophageal reflux, heart burn, food intolerance and vomiting. Aim - To devise the gastric sleeve fixation for the laparoscopic sleeve gastrectomy. Technique - The gastric tube is fixed along the new greater curvature with the gastrocolic omentum using the PDS 3-0 in continuous fashion. The interrupted suture is used to fix at the lower part of the tube with the transverse mesocolon near the lower edge of pancreas. Conclusion - the gastric fixation stratergy is safe and easy. It can reduce the problems arising from the improper gastric tube position, reducing the incidence of food intolerance and gastroesophageal disease.
