Abstract: Intrathoracic sleeve migration following laparoscopic sleeve gastrectomy and gastroesophageal reflux are currently the most concerning long-term complications. The main surgical technique for intrathoracic sleeve migration involves reducing the herniated stomach and distal esophagus from the mediastinum back into the abdominal cavity, along with hiatal hernia repair. However, hiatal repair alone has a high postoperative recurrence rate. To maintain the distal esophagus within the abdominal cavity, various approaches of gastropexy are used to prevent postoperative recurrence. The authors combine the related literature review with personal experience to discuss the role of different gastropexy techniques in the surgical treatment of intrathoracic sleeve migration following sleeve gastrectomy.