Circumcostal gastropexy has comparable strength to the belt loop gastropexy, and similarly does not have the risk of stomach leakage, as does the tube gastrotomy. Circumcostal gastropexy is more difficult to perform and the surgical procedure has potential risks of rib fracture or pneumothorax. The technique of forming the seromuscular flap in the pyloric antrum is the same as the belt loop gastropexy. The flap is passed around a rib instead of through a muscle tunnel. A 5 cm incision is made over the last rib through the peritoneum and transverse muscle layer. The flap is passed through this incision, around the rib, and then sutured back to the stomach.