Gastroesophageal reflux caused by intrathoracic sleeve migration is a common long-term complication after sleeve gastrectomy. Its essence is the displacement of the lower esophagus or part of the stomach into the mediastinum, leading to symptoms of gastroesophageal reflux, which belongs to type I sliding hiatal hernia. This video introduces our surgical approachs: reducing lower esophagus or part of the stomach back into the abdominal cavity, repairing the esophageal hiatus, followed by posterior gastric wall fixation, phrenoesophageal ligament reconstruction, left diaphragmatic crus-stomach fixation, and anterior gastric wall fixation. The patient’s acid reflux symptoms were immediately relieved after surgery. Four-points fixation can effectively prevent the recurrence of gastroesophageal displacement after the surgery.