Although supplemental enteral nutrition may have first been delivered by enema, the modern era of surgically placed feeding tubes began in the mid to late 1800s. Early procedures were generally disastrous, however, techniques rapidly improved. The basic techniques of surgical enteral access have not changed significantly in the last century, although endoscopic, radiologic and laparoscopic modifications have been described and adopted in the last 25 years. This article reviews some of the landmark surgical highlights in the United States and European literature regarding surgical enteral access.