Abstract Purpose The proposed etiology of leakage after laparoscopic sleeve gastrectomy may be the axial rotation of the stomach owing to the loss of abdominal ligament fixation along the greater curvature of the stomach. The mechanism of increased intra-gastric pressure due to axial gastric rotation may place a great deal of stress on the staple lines, leading to an increased incidence of leakage. Other complications may occur, including vomiting, food intolerance or persistent reflux. Methods This study was registered in ClinicalTrials.gov (ID: NCT04834323). This study included patients who were admitted to our center to undergo laparoscopic sleeve gastrectomy. Cases were collected in the period from December 2019 to December 2020. The study population included 83 patients, who were divided into the following two groups: Group 1 included 42 patients who received distal mesogastric fixation after laparoscopic sleeve gastrectomy; Group 2 included 41 patients who received laparoscopic sleeve gastrectomy alone without distal mesogastric fixation. Results No leakage or axial rotation occurs after laparoscopic sleeve gastrectomy with distal fixation, while in patients without distal fixation, leakage and axial rotation occurred with no statistically significant differences between the two groups. Leakage and axial rotation occurred two times more frequently among patients who received laparoscopic sleeve gastrectomy without distal fixations. Conclusion Distal mesogastric fixation after laparoscopic sleeve gastrectomy decreased the axial gastric rotation and subsequently decreased gastric leakage.