[Esophagojejunostomy after laparoscopic total gastrectomy: the 'negation of negation' from linear stapling to...

Esophagojejunostomy remains the most technically demanding step in laparoscopic total gastrectomy. This review systematically traces the spiral evolution of esophagojejunal anastomotic techniques from open circular stapling and laparoscopy-assisted circular stapling, to totally laparoscopic linear stapling (Overlap and π-shaped methods), and subsequently to the resurgence of circular stapling under totally laparoscopic and robotic-assisted platforms. Linear stapling achieves complete minimally invasive surgery by eliminating the auxiliary incision; however, it faces technical bottlenecks including limited applicability for high anastomosis, difficulty in common opening closure, and compromised anti-reflux mechanisms. Conversely, circular stapling has regained vitality on the totally laparoscopic platform through hand-sewn purse-string sutures, modified anvil insertion techniques, and robotic assistance, preserving the anatomical and physiological advantages of end-to-side anastomosis, particularly for advanced esophagogastric junction tumors. Based on domestic and international evidence together with our institutional experience, this article proposes an individualized selection framework from the dimensions of tumor location, patient body habitus, and surgeon expertise, and outlines future directions in instrument innovation, technical integration, and high-quality evidence generation, aiming to provide practical guidance for surgeons in selecting esophagojejunostomy approaches.