Objective: To investigate the application efficacy of esophagojejunostomy using the tied reverse puncture in laparoscopic radical total gastrectomy. 
Methods: The clinical data of 92 patients undergoing laparoscopic radical total gastrectomy from June 2014 to June 2018 were retrospectively analyzed. Of the patients, 46 cases underwent esophago-jejunal anastomosis using the tied reverse puncture (observation group), and the other 46 cases underwent esophago-jejunal anastomosis using the purse-string suture (control group). The main clinical variables between the two groups of patients were compared.
Results: Operations in all patients were completed uneventfully. In observation group compared with control group, the operative time was shortened (229.2 min vs. 196.2 min), the intraoperative blood loss was decreased (83.26 mL vs. 56.18 mL), the length of incision was reduced (9.08 cm vs. 3.89 cm), the proximal cut edge of the esophagus was longer (2.42 cm vs. 3.78 cm), and the time from placement of the nail anvil to completion of esophagojejunostomy was shortened (32.1 min vs. 19.2 min), and all the differences had statistical significance (all P<0.05). There were no significant differences in the time to first postoperative gas passage and length of hospital stay between the two groups (both P>0.05). No significant differences were noted in incidence of anastomotic bleeding, wound infection and anastomotic stenosis between the two groups (all P>0.05), but the incidence of anastomotic leakage in observation group was significantly lower than that in control group (0 vs. 6.52%, P<0.05). Patients in both groups were followed up for 6 to 30 months, and recurrence occurred in 2 cases in control group, but no recurrence was found in observation group.
Conclusion: Application of the tied reverse puncture esophagojejunostomy in laparoscopic radical total gastrectomy is safe and feasible. It also has the advantages of short operative time and less bleeding, and the superiorities of reducing the size of the auxiliary incision of the abdominal wall, obtaining longer cut margin, and decreasing the risk of anastomotic leakage and recurrence.