A 54-year-old male patient with gastroesophageal reflux disease was submitted to modified Nissen fundoplication. On postoperative day 2, the patient presented with nausea and vomiting after eating and an acute abdominal X-ray showed gastric herniation into the chest. The patient was sent for emergency laparoscopy, which revealed a large hiatal hernia involving the entire stomach. Surgical treatment consisting of hiatoplasty and fundoplication repair was performed. After three days, the patient developed septic shock secondary to empyema in the right hemithorax and a chest drain was placed. The methylene blue swallow test revealed leakage of the dye through the drain. Enteral fasting was maintained and the patient received exclusive parenteral nutrition. Thoracoscopy was performed for cleaning and drainage of the pleural cavity. After approximately 60 days, the enteral diet was reintroduced and there was an increase in drain output. A chest CT revealed a gastropleural fistula in the posterior area of the fundoplication. Endoscopy showed the presence of a recess in the region of the fundoplication and fistula measuring 30 mm. Using videothoracoscopy, a transfistula guidewire was inserted through the nostril and externalized through the right chest wall. Through this guide, a vacuum therapy tube (VTT) with a fenestrated film (a customized Levin 16Fr tube) was positioned inside the fistula and externalized through the chest. However, there was no improvement in the fistula in subsequent examinations. Since surgical retreatment was not feasible, we chose a VTT with a silver sponge of sufficient size to occlude the entire fistula. The sponge was changed every 7-10 days with the aid of the guidewire. We observed the formation of granulation tissue and a reduction in the size of the fistula. After four changes, the fistula had closed and the VTT was removed. The patient had resumed oral feeding and was discharged with an open chest drain. There was progressive improvement during outpatient follow-up and the chest drain was removed.