Abstract Introduction: Gastrogastric fistula is a communication between the gastric remnant and the gastric pouch. This type of fistula is a rare complication after a Roux-en-Y gastric bypass (RYGB). These types of fistulas may be caused by an anastomotic leak, marginal ulcers, distal obstruction, or erosion from a foreign body. The type of fistula may also form secondary to an undivided stomach with a subsequent staple line failure. Case Presentation: A 50-year-old female who was status post a laparoscopic RYGB at an outside facility in 2010 presented for weight gain. She lost 99 lbs in 2 years after the RYGB but then regained 43 lbs in a couple of months before presentation. At the time of evaluation, the patient's body mass index was 32 kg/m2. An upper gastrointestinal swallow study showed a gastrogastric fistula and an endoscopic gastroduodenoscopy documented the communication between the gastric pouch and remnant stomach. The patient underwent an elective laparoscopic repair of the fistula. Intraoper...