This video presents a step-by-step demonstration of laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) in a comatose patient with prior sleeve gastrectomy. The technique combines laparoscopy and endoscopy to enable safe enteral access when conventional PEG is not feasible. Under direct visualization, a PEG tube is placed while avoiding interposed structures. The procedure emphasizes careful site selection, gastric wall approximation, and postoperative considerations. LAPEG offers a valuable alternative in complex cases, highlighting the importance of tailored approaches for patients with altered anatomy or previous abdominal surgeries.