Purpose <p>In paediatric patients undergoing laparoscopic primary gastrostomy button insertion using the Vygon^™ UK MIC Introducer kit, Saf-T-Pexy fastener disc-related problems can include patients pulling at the discs, premature disc detachment, caregiver anxiety and disc-related skin irritation. We aimed to mitigate these problems by developing a technique modification involving subcutaneous knotting of T-fastener sutures after intra-operative removal of the Saf-T-Pexy T-fastener discs. This study evaluates the complication rate with our modified technique.</p> Methods <p>This is a retrospective single-centre consecutive case series of paediatric patients undergoing laparoscopic primary gastrostomy button insertion with subcutaneous knotting of T-fastener sutures between March 2022 and November 2023. Data collected included demographics, diagnosis, High-Dependency Unit requirement, operative technique, intra-operative complications, post-operative complications and follow-up duration.&#xa0;Total complication rate is the primary outcome. Descriptive statistics are used.</p> Results <p>Thirty-three patients with a median age of 3.1 (range 0.2–15.5) years were included; the median follow-up was fifteen (range 2–22) months. There were no intra-operative complications. Post-operative complications included granulation tissue (<i>n</i> = 4, 12%), early button displacement (<i>n</i> = 1, 3%) and surgical site infection (<i>n</i> = 1, 3%). The total complication rate was 18%. No complication required operative intervention.</p> Conclusion <p>This modified method of gastropexy, knotting T-fastener sutures subcutaneously obviates the use of the manufacturer’s Saf-T-Pexy discs thereby eliminating risks associated with early disc detachment and caregiver anxiety specifically related to the presence of those discs. This method appears to be safe with none of the identified complications requiring a return to theatre or re-admission.</p>