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Low‐profile G‐tubes have a port that sits flush with the skin surface (Figure 1.1c). They are more easily hidden than the standard G‐tubes simply by the nature of their size, and patients tend to prefer them for this reason. In addition, the smooth surface of a G‐tube port site without tubing is less prone to accidental dislodgement compared to standard G‐tubes. However, there are drawbacks to a low‐profile tube. First, external tubing has to be attached in order to deliver a feed, which creates one additional step and an additional piece of equipment that can malfunction. Second, low‐profile tubes cannot be adjusted to accommodate increased abdominal wall thickness and must be replaced with a tube that has a longer shaft length when there are signs of abdominal wall compression.

Although they were not designed to be placed primarily, low‐profile G‐tubes can be placed laparoscopically. In pediatric surgical practice, the laparoscopic primary G‐button gastrostomy is now widely performed. In this approach, one trocar is placed through the umbilicus and another through a small incision in the left upper quadrant. A stitch is placed in the anterior wall of the stomach and passed through the trocar in the left upper quadrant. Once the suture material is outside the abdomen, the trocar is removed and the anterior wall is pulled through the initial trocar site. The stomach and abdominal walls are sutured together. The gastrostomy is made in the portion of stomach wall that is exposed. The appropriate button is then placed in the gastrostomy and sutured in place. Similar to a surgically placed standard G‐tube, a low‐profile G‐tube tract matures in four weeks.