Objective: To investigate the safety and efficacy of using esophageal suspension method for manual esophagojejunostomy following totally laparoscopic total gastrectomy (TLTG). Methods: The clinical data of 34 patients undergoing TLTG and esophageal suspension manual esophagojejunostomy (suspension group) from January 2016 to January 2017 were retrospectively analyzed, and they were compared with the clinical data of 17 patients undergoing TLTG and traditional manual esophagojejunostomy (traditional group) during the same period. Results: The preoperative data of the two groups were comparable. Operations were successfully completed in all the 34 patients without any open conversion. In suspension group compared with traditional group, except for the length of incision that showed no significant difference (3.75 cm vs. 3.79 cm, P=0.142), the intraoperative variables that included the operative time (198.35 min vs. 211.65 min), anastomosis time (27.82 min vs. 48.74 min) and blood loss (49.68 mL vs. 50.85 mL) were all significantly improved (all P<0.05); the postoperative variables that included the time to gas passage (2.61 d vs. 2.78 d), pain score (3.21 vs. 3.89) and length of hospitalization (9.77 d vs. 10.32 d) were all significantly improved (all P<0.05). No relevant postoperative complications occurred in patients of both groups. Conclusion: Using esophageal suspension method for manual esophagojejunostomy during TLTG is safe and effective, with short-term efficacy superior to that of traditional esophagojejunostomy method.