total gastrectomy results in a reduction of food intake , malnutrition , malabsorption , and weight loss .
this is due in part to the loss of the secreting function of the stomach , but also to the loss of the reservoir function and the subsequent postgastrectomy syndromes ( early dumping , late dumping , diarrhea , etc . ) .
most of them attempted the creation of a pouch in order to improve the food intake and slow the transit .
reconstruction using a jejunal interposition is more complicated and less suitable than the simple classic roux - en - y reconstruction .
according to several prospective randomized trials and a recent meta - analysis , the roux - en - y jejunal pouch reconstruction [ figure 1 ] appears to be the best technique for reconstruction ; it improves the feeding , the weight recovery , and the quality of life after gastrectomy , particularly in patients with an expected survival longer than 6 months .
after performing a total gastrectomy associated to a formal over - d1 lymphadenectomy and a systematic cholecystectomy , a jejunal pouch is constructed according to the following technique [ video 1 ] .
the jejunum is divided 20 cm distal to the treitz ligament with a linear stapling device .
the proximal end of the roux limb is folded up to create an  inverted j  , 15 cm long .
the future pouch is opened near the jejunal stump and the two limbs are side - to - side anastomosed together applying successive charges of 60-mm length linear stapler cephalad , as far as 1 - 2 cm from the intestinal bend .
a mucus bridge remains at the top of the pouch that it is not necessary to cut .
the end - to - side esophagojejunostomy is performed with a 25 mm diameter circular stapler that is introduced through the same orifice used for the linear stapler .
an end - to - side hand - sewn jejunojejunal anastomosis is performed with two absorbable running sutures 60 cm distally to the top of the pouch .
this procedure could be performed laparoscopically - assisted ; however , the construction of the jejunal pouch is challenging .
if it is , note that a whitish secretion coming from the secreting jejunal mucosa of the pouch is usually found in the first postoperative days and should not be mistaken for a postoperative complication .
even if drains are not mandatory after total gastrectomy , we use to put a low - pressure aspirative drain in the vicinity of the esophagojejunal anastomosis , as well as another one close to the duodenal stump . before restarting oral nutrition ,
the esophagojejunal anastomosis is controlled with a water - soluble contrast swallow x - ray 6 days after surgery [ figure 2 and video 2 ] .
 total gastrectomy for cancer results in many digestive troubles leading to an impairement of the quality of life . 
 different types of reconstruction have been proposed to improve the postoperative digestive functions . according to several prospective randomized trials and a recent meta - analysis 
 , the roux - en - y jejunal pouch construction appears to be the best technique for reconstruction concerning the postoperative quality of life . 
 however , this safe reconstructive surgery is not still recognized as a gold standard . 
INTRODUCTION
TECHNIQUE
POSTOPERATIVE MANAGEMENT
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