ObjectiveTo compare clinical efficacy of totally laparoscopic gastrectomy (TLG) and conventional laparoscopy-assisted gastrectomy (LAG) and to explore safety and feasibility of total laparoscopic anastomosis in laparoscopic gastrectomy. MethodThe clinical data of 64 patients who received TLG and another 70 patients who received conventional LAG in our department from January 2013 to March 2014 were retrospectively analyzed. ResultsAll procedures were completed successfully. There were no significant differences in the time of anastomosis〔(73.8±10.3) min versus (72.7±8.9) min, t=0.693, P=0.489〕 and the number of dissected lymph nodes (32.4±9.7 versus 33.6±9.6, t=-0.700, P=0.485) between the patients underwent TLG and the patients underwent LAG. However there were obvious differences in the blood loss〔(275.0±66.3) mL versus (364.3±75.7) mL, t=-7.419, P=0.000〕, the incision length〔(3.0±0.8) cm versus (7.3±1.7) cm, t=-19.354, P=0.000〕, the time to fluid diet〔(4.9±0.8) d versus (6.0±0.7) d, t=-8.750, P=0.000〕 and the time to flatus 〔(2.8±0.8) d versus (3.9±0.8) d, t=-8.388, P=0.000〕, the off-bed time〔(1.3±0.5) d versus (3.4±1.2) d, t=-14.118, P=0.000〕, and the hospital stay〔(9.8±1.2) d versus (13.0±1.5) d, t=-17.471, P=0.000〕 between the patients underwent TLG and the patients underwent LAG. Meanwhile it was found that the postoperative pain score〔On day 1 postoperatively: (3.4±0.8) points versus (6.2±1.3) points, t=-15.509, P=0.000; on day 3 postoperatively: (1.7±0.6) points versus (4.0±0.8) points, t=-18.799, P=0.000〕 and the dosage of pain killers (1.7±0.7 versus 4.0±2.1, t=-8.912, P=0.000) in the patients underwent TLG were significantly lower than those in the patients underwent LAG. One patient developed anastomotic leakage and 3 patients developed anastomotic stenosis in the patients underwent LAG, the complication rate related to the anastomosis was 5.7% (4/70). While there were no complications related to the anastomosis in including anastomotic leakage, stenosis, and bleeding in the patients underwent TLG. ConclusionsTotal laparoscopic anastomosis is safe and feasible in laparoscopic gastrectomy for gastric cancer. Compared with small incision-assisted anastomosis, totally laparoscopic anastomosis is associated with minimal trauma, less blood, quicker postoperative recovery, shorter time, slighter pain and satisfactory short-term efficacy.