Purpose <p>Gastrostomy serves as an essential device for children with insufficient oral intake. Laparoscopic techniques are increasingly used and considered safe, although minor complications remain common. The purpose of this prospective observational study was to compare three different laparoscopic gastrostomy techniques and evaluate the incidence of complications at three months postoperatively.</p> Methods <p>Children &lt; 18 years of age scheduled for gastrostomy at participating centers between 2014 and 2019 were included. Data on demographics, perioperative details, and three-month postoperative complications were collected. Three laparoscopic techniques were compared: Method A (intracorporeal double U-stitch), Method B (mini-laparotomy with fascial and stomach purse-string sutures), and Method C (extracorporeal double U-stitch combined purse-string suture).</p> Results <p>A total of 310 patients (median age: 27.0 months, median weight: 10.9&#xa0;kg) from three centers were included. Three months postoperatively, the incidence of granuloma was significantly higher in Method B (89.7%) compared to Method A (59.3%) and Method C (35.2%) (<i>p</i> &lt; 0.001). Method C had the lowest rates of granuloma, infection, leakage, and pain, while dislocation rates were similar across methods.</p> Conclusion <p>Our findings suggest that a surgical technique with a small skin incision and less suture material positioned away from the gastrostomy site may help reduce postoperative complications, particularly granuloma.</p>