Patients with neuromuscular disease often require gastrostomy, yet respiratory complications in these patients can preclude the use of general anesthesia, intravenous sedation, or endoscopy. The purpose of this study is to report successful use of open gastrostomy that can be performed under local anesthesia. Fifty-four patients underwent this modified procedure. There were no deaths or complications. They lived an average of 43.4 +/- 6.2 (SE) months postgastrostomy tube placement. Simplified open gastrostomy can be performed safely for patients with neuromuscular disease with resulting improvements in both longevity and quality of life.