Objective To compare the short-term efficacy between laparoscopic and open total gastrectomy on stage Ⅰ gastric cancer. Methods A total of 89 patients with clinical stage Ⅰ gastric cancer who underwent total gastrectomy were divided into two groups: Laparoscopic total gastrectomy group (n=47) and open total gastrectomy group (n=42). The short-term curative effect of two groups was compared. Results The preoperative data of the two groups were comparable. Compared with open total gastrectomy group, the operative time in the laparoscopic total gastrectomy group was longer, but the intraoperative blood loss, the time for bowel function recovery, the length of hospital stay and the incidence of postoperative complications were all significantly reduced (P < 0.05). Conclusion Compared with the open total gastrectomy, laparoscopic total gastrectomy is safe and feasible for stage Ⅰ gastric cancer patients. It could reduce the bleeding volume, the time for bowel function recovery, the length of hospital stay and the incidence of postoperative complications.