PurposeA meta-analysis was performed to compare the rates of the major complications associated with two gastrostomy tube placement techniques in a pediatric population: laparoscopy-assisted gastrostomy (LAG) and percutaneous endoscopic gastrostomy (PEG).MethodsThe PubMed electronic database was queried for comparative studies of the two insertion techniques. The Newcastle–Ottawa scale (NOS) was used for the assessment of the quality and risk of bias in the included studies. The main outcome measure was the frequency of major complications defined as the need for reoperation within 30 days or death. RevMan 5.3, was used, with a p < 0.05 indicating statistical significance.ResultsEight studies including 1550 patients met the inclusion criteria. The risk for major complications was higher in PEG than in LAG 3.86 (95% confidence interval 1.90–7.81; p < 0.0002). The number needed to treat to reduce one major complication by performing LAG instead of PEG was 23. There were no randomized-controlled trials. Overall, the quality of the included studies was determined to be unsatisfactory.ConclusionsPEG placement was associated with a significantly higher risk of major complications compared to LAG placement. Therefore, LAG should be the preferred method for gastrostomy tube placement in children.