A surgical method includes forming a first tissue fold, piercing the first tissue fold with a needle, deploying a first tissue anchor from the needle, withdrawing the needle from the first tissue fold, deploying a second tissue anchor from the needle, with the first tissue anchor connected to the second tissue anchor to form a first tissue anchor pair, and attaching a gastrointestinal implant to the tissue anchor pair. The gastrointestinal implant may have a tether including a tether loop, with the gastrointestinal implant attached to the tissue anchor pair by positioning the tether loop between the tissue fold and first or second tissue anchor. The gastrointestinal implant may be a gastric sleeve or a device holding microbiota.
