Objective To evaluate the application effect of modified jejunostomy in thoracoscopic Ivor-Lewis esophagectomy. Methods A retrospective analysis of patients who underwent Ivor-Lewis esophagectomy for middle and lower esophageal cancer from 2017 to 2023 in Department of Cardiothoracic Surgery, Anqing Municipal Hospital was performed. The patients from 2017 to 2020 receiving "C+I" in the upper jejunum according to the "C+I" model, with fistula fixed with only two purse-string sutures and the abdominal wall were allocated into a group A. The patients from 2021 to 2023, on the basis of "C+I" suture, with the jejunum and abdominal wall fixed with 3-0 absorbable thread for 1-2 needles at the proximal or distal end of the fistula 10-15 mm, and the upper jejunum and abdominal wall fixed into "curtain" were allocated into a group B. The operation time, jejunostomy time, postoperative pathological stage, and enteral nutrition-related complications such as the incidence of incomplete intestinal obstruction, closed loop intestinal obstruction and intestinal volvulus requiring secondary surgery, skin redness and swelling of intestinal fluid leakage, stoma tube blockage, and accidental extubation were compared between the two groups. Results A total of 243 patients were enrolled in this study. The group A consisted of 118 patients (72 males, 46 females) with a mean age of (64.58±6.30) years. The group B consisted of 125 patients (76 males, 49 females) with a mean age of (65.11±6.81) years. All patients successfully underwent thoracoscopic Ivor-Lewis esophagectomy without perioperative mortality. There were no statistical differences between the two groups in operative time, jejunostomy creation time, or the rate of feeding tube occlusion (P>0.05). However, statistical differences were observed in the incidence of incomplete intestinal obstruction (P=0.035) and closed-loop intestinal obstruction requiring reoperation (P=0.017). The incidence of complications at the stoma site, such as intestinal fluid leakage and redness/swelling, was significantly higher in the group A (n=36) than that in the group B (n=7) (P<0.001). Conclusion The modified jejunostomy can significantly reduce the incomplete intestinal obstruction, closed loop intestinal obstruction and secondary operation rate after "C+I" jejunostomy, and significantly improve the leakage of intestinal fluid at the stoma and the injury of surrounding skin and soft tissue. Improvements in certain technologies reduce operational difficulties.