Percutaneous endoscopic gastrostomy (PEG) replaced open surgical gastrostomy (OSG) as the preferred method for enteric access soon after its introduction in 1980. Since that time, laparoscopic gastrostomy (LG), percutaneous radiologic gastrostomy (PRG), and laparoscopic-assisted PEG (LAPEG) have been introduced. PEG and PRG have been found to be over 95 per cent successful, convenient, economical, and associated with less morbidity than OSG. However, there are patients that are not appropriate candidates for, or have failed attempts at, PEG or PRG placement. At one time, OSG was the only option left for these patients, but they may be better served by LAPEG or, in some cases, LG. LAPEG offers less morbidity than OSG by having less pain and wound complications, and potentially may avoid the use of general anesthesia. We present a series of patients that underwent successful LAPEG placement after an unsuccessful attempt at PEG placement, and we describe its role in patient care.