Intra-Operative Twisted Gastric Sleeve: What Now?

Laparoscopic sleeve gastrectomy (SG) is the most common bariatric surgery performed worldwide, valued for its effectiveness in weight loss and in comorbidity resolution. However, complications such as gastric twist (also known as gastric torsion or volvulus) may require conversion procedures, like the Roux-en-Y gastric bypass (RYGB). We aimed to examine SG indications, the causes and risks of gastric twisting, and evidence supporting RYGB as a corrective strategy, supplemented by a surgical video. The video demonstrates the intraoperative detection of a twist during leak testing and the subsequent conversion to RYGB. Careful assessment during the methylene blue test may reveal functional obstruction, potentially preventing delayed complications.