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A circumcostal gastropexy is similar to a belt‐loop gastropexy but the seromuscular flap is passed around the last rib, although there are several variations of the technique [60, 67, 77]. Studies have reported a recurrence rate of 0–6.9% for circumcostal gastropexy [60, 63, 66, 77, 78]. This technique has been associated with complications including pneumothorax and rib fracture [60, 77]. Although greater tensile strength compared with other techniques has been identified [66], the importance of this strength is questionable; the authors of this chapter do not believe that it offers any significant advantage over incisional or belt‐loop gastropexy.

Figure 8.11 Series of intraoperative images showing the technique for tube gastropexy. (a) Stab incision in right abdominal wall, caudal to the last rib. (b) The stomach tube (a mushroom‐tipped catheter) is passed through the stab incision with the aid of forceps. (c) The tip of the catheter is being placed into the gastric lumen through a stab incision in the center of a preplaced purse‐string suture. (d) The first of four “box” sutures has been placed between the abdominal wall and stomach. (e) The four sutures have been placed, completing the tube gastropexy. The tube is anchored to the skin with a Roman sandal suture.