Abstract: Objective To explore the application value of manual purse-string suture in esophageal jejunum tubular anastomosis in total laparoscopic total gastrectomy.Methods A retrospective cohort study was conducted to collect the clinical data of 41 patients with gastric cancer who underwent laparoscopic total gastrectomy in the Department of Gastrointestinal Surgery,Jingmen Central Hospital from January 2020 to December 2023.Among them,22 cases underwent total laparoscopic radical total gastrectomy with manual purse-string suture (total laparoscopic group),Nineteen patients underwent traditional laparoscopic-assisted total gastrectomy (laparoscopic-assisted group).Results 41 patients were successfully completed surgery,no conversion to laparotomy,no perioperative death.The operation time of the total laparoscopic group and laparoscopic-assisted group was 397.50 (310-540) minutes and 350 (250-440) minutes.The intraoperative blood loss was 50 (10-400) ml and 100 (20-200) ml.The incision length was 5 (4-5) cm and 8 (6-10) cm.The duration of postoperative analgesic use was 4 (3-5) days and 5 (3-5) days.The hospitalization days were 23 (18-37) days and 26 (13-34) days,respectively,and the difference was statistically significant (P<0.05).There was no significant difference in the number of lymph node dissection,postoperative abdominal bleeding,postoperative anastomotic leakage,postoperative anastomotic stenosis,postoperative pulmonary infection,postoperative first exhaust time and postoperative ambulation time between the two groups (P> 0.05).Conclusion It is safe and feasible to perform esophagojejunostomy by hand purse-string suture in totally laparoscopic total gastrectomy.Compared with traditional laparoscopic-assisted total gastrectomy,it has smaller incision,less intraoperative blood loss,less postoperative pain,shorter hospitalization time,but longer operation time.

Key words: gastric cancer, complete laparoscopic, total gastrectomy, tubular stapler, improved reverse puncture method