Gastro-gastric fistula (GGF) formation is an uncommon complication after divided laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity. Optimal surgical management remains controversial. A retrospective review was performed of a prospectively maintained database of all patients undergoing LRYGB from Jan 2001 to Oct 2006. Of 1763 primary procedures, 34 patients (1.9%) developed a GGF; 10 (0.6%) resolved with conservative medical management while 23 (1.3%) required surgical intervention. Of those requiring surgery, 5 (22%) had their primary RYGB at another institution, 91% of primary RYGB were completed laparoscopically, and an antecolic antegastric approach was used in 78%; M:F 1:5, mean age 41 yrs (range 26-58), mean BMI 49 kg/m2 (range 35-61). Diagnosis was achieved with a combination of upper gastrointestinal endoscopy, oral contrast studies, and abdominal CT. Indications for surgery included weight regain, recurrent or non-healing gastrojejunal (GJ) ulceration with persistent abdominal pain and/or haemorrhage, and/or recurrent GJ anastomotic stricture. Remnant gastrectomy with excision or exclusion of the GGF was performed in 21 patients (91%) with an average length of hospital stay of 7.5 days (range 3-27). Morbidity in 5 patients (22%) was due to pneumonia, wound infection and staple line bleed. There were no mortalities. Complete resolution of patient symptoms and associated ulceration was seen in all patients. In conclusion, remnant gastrectomy is an effective surgical option in the management of symptomatic GGF after LRYGB.