Background and Aims Totally laparoscopic π-shaped esophagojejunostomy is a new digestive tract reconstruction method after laparoscopic total gastrectomy. There are a number of studies comparing this method with the conventional laparoscopic-assisted Roux-en-Y esophagojejunostomy under the traditional clinical pathway, but few reports comparing the two methods under the clinical pathway of enhanced recovery after surgery (ERAS). Therefore, this study was conducted to compare the clinical effects of totally laparoscopic π-shaped esophagojejunostomy and laparoscopic-assisted Roux-en-Y esophagojejunostomy following laparoscopic total gastrectomy in ERAS pathway.Methods The clinical data of 65 patients undergoing surgery for gastric cancer from June 2017 to December 2019 were analyzed retrospectively. All patients entered the ERAS pathway and underwent laparoscopic total gastrectomy. Of them, totally laparoscopic π-shaped esophagojejunostomy was used to reconstruct the digestive tract in 30 cases (π-shaped anastomosis group) and laparoscopic-assisted Roux-en-Y esophagojejunostomy was used to restore the digestive tract in 35 cases (Roux-en-Y anastomosis group). The intra- and postoperative variables and follow-up data were compared between the two groups.Results The preoperative date of the two groups were comparable. The incision length, the time to first postoperative ambulation, time to first anal gas passage, time to first food intake, postoperative pain and length of hospitalization in π-shaped anastomosis group were superior to those in anastomosis Roux-en-Y group (all P<0.05). There were no significant differences in operative time, intraoperative blood loss, total number of lymph node dissection, total hospitalization cost and overall incidence of postoperative complications between the two groups (all P>0.05). During postoperative follow-up, different degrees of metastasis and recurrence occurred in 4 patients in π-shaped anastomosis group and 6 patients in Roux-en-Y anastomosis group, and the difference had no statistical significance (P>0.05). The one-year survival rate was 73.33% in π-shaped anastomosis group and 77.14% in Roux-en-Y anastomosis group, and the difference had no statistical significance (P>0.05).Conclusion After laparoscopic gastrectomy, using totally laparoscopic π-shaped esophagojejunostomy has the advantages of small trauma, quick recovery and short hospitalization period, and its advantages can be enhanced with ERAS pathway.