Background

Gastrogastric fistula (GGF) after a Roux-en-Y gastric bypass is a communication between the gastric pouch and the remnant. Symptoms include nausea, vomiting, and weight regain. We are presenting a 41-year-old female patient with a history of an open partitioned gastric bypass, with chronic symptoms of GGF, which was confirmed on imaging (Upper Gastrointestinal Series). The patient underwent 2 endoscopic closures with gastroenterology, however, the attempts were unsuccessful, leading to a referral back to bariatric surgery for repair, where a robotic approach allowed the repair of the GGF. Surgical repair is definitive, and simultaneous endoscopic assistance allows to identify anatomy, defects, and to prevent stapling across plastic or metal hardware used for the endoscopic suturing