ObjectiveTo investigate the application value of the bidirectional sutures method in total laparoscopic radical total gastrectomy with esophagojejunal overlap anastomosis. MethodsA retrospective descriptive study was conducted. A retrospective analysis was performed on 128 patients with gastric cancer who underwent totally laparoscopic total gastrectomy (TLTG) in the Department of Gastrointestinal Surgery of Chengdu Third People's Hospital from December 2020 to December 2023. Patients in the observation group underwent bidirectional suture overlap esophagojejunostomy, 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 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 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 at 1, 3, 6, and 12 months 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. ConclusionsThe bidirectional suture overlap esophagojejunostomy is a safe and feasible technique for performing a totally laparoscopic radical total gastrectomy, providing favorable short-term effects.