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A gastropexy with T-fasteners can maintain gastric apposition to the abdominal wall before a mature gastrocutaneous fistula. In patients at high risk for inadvertently removing their percutaneous endoscopic gastrostomy tube, or those in whom early, unintentional removal and subsequent laparotomy would be catastrophic, the T-fasteners can act as a safety mechanism. We present a case of an obese patient, for whom a surgical gastrostomy was not practical, and the T-fastener system had inadequate length to traverse the abdominal wall. Innovatively a fascial closure device was used in a similar fashion to create an equivalent gastropexy. Obesity frequently complicates surgical and critical care, providing additional technical challenges. We must continue to be creative and innovatively utilize current equipment to deliver more effective and safer care for this unique patient population.