To evaluate the clinical efficacy of totally laparoscopic total gastrectomy (TLTG) with different methods of esophageal and jejunal anastomosis.

A retrospective analysis of four hundred and twenty-five patients with TLTG in Tongcheng County People's Hospital of Xianning from October 2011 to July 2016 was performed. The patients were divided into the end to side anastomosis group (Group A), the side anastomosis group (Group B), the triangle anastomosis group (Group C) and the manual suture group (Group D), according to different methods of the anastomosis of the esophagus and jejunum. The clinical data including operation time, time of anastomosis, postoperative eating and complication rate were compared and analyzed.

Preoperative ASA classification divided the 425 patients into 219 of grade Ⅰ, 192 of grade Ⅱ, 14 of grade Ⅲ. There were no significant differences on ASA and the number of lymph node among four groups. No deaths occurred during the perioperative period. The complication rate of Group D was 7.5%, which was lower than 25.3% of Group A, 22.6% of Group B and 11.1% of Group C, the difference was statistically significant (P<0.05). There was no significant difference among the four groups in the length of operation, the time required for the anastomosis and the postoperative feeding. The amount of bleeding, time of exhaust and length of hospital stay in Group D were significantly shorter than those of the other three groups (F=5.744, 4.325, 5.687, P=0.032, 0.025, 0.021).

TLTG has the advantages of less trauma, less bleeding and quick recovery after operation. There are advantages and disadvantages in the clinical application of different methods of esophageal and jejunal anastomosis, among which laparoscopic manual suture is relatively safe and feasible.