Abstract Percutaneous endoscopic gastrostomy (PEG) is the choice technique to establish a feeding route for patients that requiring special nutritional support for more than 4 weeks; however, to be an intervention performed percutaneously, the inability to demonstrate transillumination of the abdominal wall and the failure to obtain convexity with the fi nger-pressure are usually considered contraindications for its realization.This report is about a case in which spite of a major contraindication for PEG, it was performed under laparoscopic guidance, thus providing a minimally invasive alternative, avoiding the realization of an open surgical procedure. Keywords PEG, percutaneous endoscopic gastrostomy, laparoscopy INTRODUCTION Since its introduction in 1980, percutaneous endoscopic gastrostomy (PEG) has become the procedure of choice for establishing a feeding route for patients who require more than 30 days of special nutrition (1-3). Th e proce-dure is performed successfully in 95% of the cases (4). Nevertheless, certain characteristics of a patient can absolutely contraindicate this procedure’s performance. When it is impossible to move the anterior gastric wall until it makes contact with the abdominal wall, transillumina-tion of the stomach is impeded for diff erent reasons. Th ese include obesity, severe scoliosis, peritoneal adhesions secondary to surgery, prior gastric resection, ascites and hepatomegaly (5, 6). Complications from this procedure are not infrequent and have been classifi ed by Schapiro as major and minor complications (7). An example of a minor complication is a leak through a stoma which is present in up to 78% of these cases (8). Major complications appear in 3% of cases (9, 10). Th ey include aspiration, peritoni-tis, hemorrhaging, catheter migration, gastrointestinal cutaneous fi stulas, and serious infections of lesions with necrotizing fasciitis. Th ey also include rarer rare ones such as tumor seeding in stoma of patients with oropharyngeal neoplasias, aortic-gastric fi stulas, intrahepatic catheter pla-cement, gastric volvulus, subcutaneous emphysema and persistent pneumoperitoneum (11).Even though there have been reports of laparoscopic-assisted PEG (12-16), various management guides do not contemplate this procedure as an alternative when there is no safe access to the gastric cavity. According to these guides, this procedure is contraindicated under these cir-cumstances resulting in a recommendation of open surgical gastrostomies for these cases (1, 5, 17,18).