Laparoscopic gastrostomy is a relatively new procedure which does not require a laparotomy but which allows direct visualization of the gastrostomy tube entering the stomach and the stomach-parietal peritoneum interface. The role of the laparoscopically placed gastrostomy for enteral access has yet to be defined. Our aim was to compare laparoscopic gastrostomy with open surgical gastrostomy to determine the effectiveness and safety of laparoscopic gastrostomy as a method for obtaining long term enteral access. We reviewed the records of 32 patients (December 1992 to April 1994) who had laparoscopic gastrostomy (group I) and 37 patients (January 1987 to December 1993) who had open gastrostomy (group II). The indications, length of operation, and morbidity and mortality rates in both groups were compared. The underlying diseases and indications for gastrostomy placement were similar in both groups. Both groups included primarily patients who were not candidates for upper endoscopy. Operative time was significantly shorter in the laparoscopic gastrostomy group (38 +/- 7 min) than in the open gastrostomy group (62 +/- 19), P < 0.0001. Major complication for laparoscopic gastrostomy was 6% and for open gastrostomy was 11%. There was no procedure-related mortality in group I and three patients in group II died in the immediate postoperative period. Major morbidity and mortality rates were not significantly different between the two groups. Laparoscopic gastrostomy is a safe and effective alternative to open gastrostomy, particularly in patients unable to undergo upper endoscopy or in patients undergoing a concomitant laparoscopic procedure.