Objective To compare the effects of combined sevoflurane anesthesia and total intravenous anesthesia with propofol on perioperative neurocognitive disorder (PND) in elderly patients during laparoscopic surgery. Methods A total of 98 patients, aged 60-75 years, and American Society of Anesthesiologists grades Ⅰ or Ⅱ, who underwent laparoscopic surgery in the People's Hospital of Shiyan from September 2019 to September 2020 were enrolled. According to the random number table method, the patients were divided into two groups (n=49): a combined sevoflurane anesthesia group (group S) and a total intravenous anesthesia with propofol group (group P). On the basis of the same other anesthetics in the two groups, group S continued to inhale 2.0%-3.5% sevoflurane, while group P received target‑controlled infusion of propofol, where the plasma target concentration was maintained at 3-6 mg/L. Both groups were compared for intraoperative conditions (anesthesia time, operation time, blood loss, fluid volume, and remifentanil dosage) and postoperative recovery [extubation time, the length of postanesthesia care unit (PACU) stay, and postoperative Visual Analogu Scale (VAS) score at 3 days]. Their mean artery pressure (MAP) and heart rate before intubation (T0), after intubation (T1), after operation (T2), and after entering the PACU (T3), and the incidence of PND 3, 5, 7, and 30 days after surgery were recorded. Results Compared with group S, group P showed decreases in the extubation time and the length of PACU stay (P<0.05), and decreases in the incidence of PND 3, 5, and 7 days after operation (P<0.05). There was no statistical difference in the operation time, anesthesia time, blood loss, fluid volume, remifentanil dosage, heart rate and MAP at each time point, postoperative VAS pain score at 3 days, and the incidence of PND 30 days after operation between the two groups (P>0.05). Conclusions Compared with sevoflurane anesthesia, total intravenous anesthesia with propofol can shorten the extubation time and the length of PACU stay, and reduce the short‑term incidence of PND, suggesting that total intravenous anesthesia with propofol may be more beneficial for elderly patients.