Esophagogastric fistula is an extremely rare complication of Nissen fundoplication surgery. Progressive dysphagia and odynophagia are the most frequent symptoms reported. Diagnosis is usually made two or three years after surgery, and although endoscopy is the gold standard to confirm diagnosis, radiologic barium swallow typically shows an image of a double column at the lower third of the esophagus and must be recognized as pathognomonic in patients with dysphagia after Nissen fundoplication. We report the first case completely resolved by laparoscopy and we recommend this approach in selected cases.