Minimally invasive surgery is currently becoming an accepted approach to esophageal cancer treatment. At the authors' Department laparoscopic gastroplasty is used in combination to either transhiatal or transthoracic esophagectomy, associated with left cervicotomy and right thoracotomy, respectively. Outcomes of laparoscopic and open gastric mobilization during esophagectomy in terms of intra- and postoperative complications are compared. From February 2003 to September 2005 45 patients underwent laparoscopic gastroplasty (group A) and 26 patients underwent open gastroplasty (group B) during esophagectomy. Intraoperative complications were 2% vs. 11.5%; respiratory complications were 2.2% vs. 19%; leakages from the suture lines were 17.7% vs. 7.6% (p = n.s.); major long-term complications were 4.4% vs 3.8% (p = n.s.), respectively. Laparoscopic gastroplasty during esophagectomy was shown to be a safe procedure. Intraoperative splenic lesions were rare; respiratory complications seemed decreased after the laparoscopic approach in comparison to open gastroplasty; major long-term complications were specific to the open or laparoscopic approach.