Currently, sleeve gastrectomy (SG) is the most performed bariatric procedure in the United States. Notwithstanding its proven safety, SG is related to a non-negligible risk of complications, including food intolerance, gastroesophageal reflux disease, and gastric fistulae.Several mechanisms can contribute to these complications, and the twisting of the remnant stomach, which can occur in 1-10% of cases, appears to play a role on it.During SG, the greater curvature is completely released from the greater omentum, making the stomach more mobile and prone for twisting. Another mechanism for occurrence of twist is sleeve scarring with adhesion formation, leading to a kinking of the gastric tube at the incisura angularis. Rotation of the staple line, leading to a focal area of fixed narrowing that requires surgical correction.
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