Gastropexy via a percutaneous endoscopic gastrostomy has been used for fixation of the stomach to the anterior abdominal wall in patients with hiatal hernias who are poor candidates for more extensive procedures. Altered anatomic relationship of the stomach to other intra-abdominal organs and the abdominal wall may prevent safe placement endoscopically. Visualizing and manipulating the stomach with laparoscopy enables the surgeon to complete the procedure and diminishes the risk of injury to the adjacent organs without compromising the minimally invasive approach.