ObjectiveTo investigate the application value of bidirectional sutured esophagojejunal Overlap anastomosis in totally laparoscopic total gastrectomy (TLTG). MethodsA retrospective analysis was performed on 128 patients with gastric cancer who underwent TLTG in the Department of General Surgery, The Third People’s Hospital of Chengdu/Clinical College of Southwest Jiaotong University·The Affiliated Hospital of Southwest Jiaotong University from December 2020 to December 2023. Patients in the observation group underwent bidirectional sutured esophagojejunal Overlap anastomosis, while patients in the control group received conventional Overlap side-to-side esophagojejunostomy. The two groups were then compared based on clinical outcome measures. ResultsA total of 128 patients were included, including 80 in the observation group and 48 in the control group. The intraoperative anastomosis time [(25.75±5.78) min vs (29.43±2.73) min, P＜0.001], operative time [(244.81±39.16) min vs (257.18±44.36) min, P=0.037], time to postoperative flatus [(2.30±0.80) d vs (2.85±1.33) d, P=0.004], and postoperative hospital stay [(7.15±2.10) d vs (9.00±2.66) d, P＜0.001] of the observation group were shorter than those in the control group. In the observation group, anastomotic leakage occurred in one patient (Clavien-Dindo grade Ⅱ), who improved with conservative treatment and was discharged. All patients were successfully followed up after surgery, and the median follow-up time was 12 months. During follow-up, four deaths occurred (two in the observation group and two in the control group), all non-cancer-related. No other complications, recurrences, or metastases were observed. ConclusionBidirectional sutured esophagojejunal Overlap anastomosis is safe and feasible in TLTG, providing favorable short-term effects.