Percutaneous endoscopic gastrostomy (PEG) has become an effective alte
rnative to surgical gastrostomy in patients who require enteral access
or gastric decompression. Technical considerations, however, limit th
e application of PEG in selected patients and those who have contraind
ications to PEG. Laparoscopic gastrostomy tube placement has been intr
oduced as an alternative to PEG. A technique for laparoscopic gastrost
omy tube placement that emphasizes four-point fixation of the anterior
gastric wall is presented.