Biliary fistula (BF) is an underestimated complication, which can lead to high morbidity, mortality, prolonged hospitalization, and a deterioration in patients’ quality of life. Although some cases of BF due to spontaneous acalculous gallbladder perforation and bile leak (BL) from the left triangular ligament are described in the literature, the main cause of BL during gastric resection for cancer (GRC) is still represented by the iatrogenic biliary fistula (IBF). When feasible, intraoperative diagnosis and treatment of BF is the best way to improve the prognosis of patients. As far as postoperative management is concerned, a multidisciplinary approach is essential, with the participation of interventional radiologists, endoscopists, and surgeons.