Objective To retrospectively analyze the effect of right anterior approach and left posterior approach laparoscopic radical gastric cancer (LG) for distal gastric cancer (GC) and the effect on complications. Methods Clinical data of 80 patients with distal gastric cancer (GC) treated at Shangqiu City Hospital from January 2021 to December 2023 were collected. Patients were divided into two groups based on different surgical approaches: the study group (40 patients) who underwent right anterior approach laparoscopic gastrectomy (LG) and the control group (40 patients) who underwent left posterior approach LG. The perioperative indicators, tumor marker levels [carbohydrate antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA)], gastrointestinal function-related indicators [diamine oxidase (DAO), pepsinogen I (PGI), D-lactate], gastrointestinal symptom rating scale (GSRS), and complication rate were compared between the two groups. Results Compared to the control group, the study group exhibited reduced intraoperative blood loss, shorter durations for surgery, bowel sound recovery, exhausting, and resuming food intake, as well as an increased number of lymph node dissections (P<0.05). At 3 days post-surgery, upon discharge, and at 1 month, the GSPS scores of the study group were significantly lower than those of the control group, as were the levels of CA125, CEA, and CA19-9 at 3 days post-surgery (P<0.05). At 3 days post-surgery, the study group had lower levels of D-lactate and DAO, and higher levels of PGⅠ compared to the control group (P<0.05). There was no significant difference in the incidence of complications between the two groups post-surgery (P>0.05). Conclusion Treatment with LG via the right anterior approach in distal GC can reduce tumor burden, improve gastrointestinal dysfunction in patients, cause minimal trauma, increase lymph node clearance rate, and facilitate postoperative recovery.