A gastrostomy tube placement is a frequently performed procedure to benefit children with feeding difficulties. The majority of these children have a significant neurological impairment. There are many complications associated with the gastrostomy tube insertion such as bowel injury, early tube dislodgement, intraperitoneal leakage either before and after gastrostomy tube exchange, persistent gastrocutaneous fistula which requires reoperation under general anesthesia. Aim of the work: Assessment of incidence and risk factors of complications associated with the gastrostomy tube placement requiring reoperation. Patient and methods: All Patients underwent surgical gastrostomy tube insertion either by open or laparoscopic-assisted approach in the Pediatric Surgery department, Mansoura University Children’s Hospital were included. The study was performed by reviewing patients` medical records during the period from Jan 2017 to June 2022. One hundred forty seven patients were included in this study and were divided into two groups: Group A refers to patients operated by the open approach. Group B refers to cases operated by the laparoscopic-assisted approach. Results: This study included 147 patients who underwent gastrostomy. Group A included 93 patients with mean age of 12.8+/-12 months. Group B included 54 patients with mean age of 35+/-12 months. In Group A, number of male patients was 53 with percentage (56.9%) while number of female patients was 40 with percentage (43.01%), while in Group B, number of male patients was 29 with percentage (53.7%) while number of female patients was 25 with percentage (46.3%). The mean operative time for group A was 48.2 ± 4.0 min, while in group B was 24.8 ±3 min. Postoperative complications occurred in 29 cases (31.18%) in group A compared to 22 cases (40.74%) in group B. Incidence of gastrostomy related major complications requiring reoperation in group A was 15.05% (14 patients), while in group B was 22.2% (12 patients). Conclusions: Laparoscopic assisted gastrostomy tube insertion offers fast, safe and efficient approach with no statistically significant difference in major complications compared to the open approach.