Controversial results have been reported regarding the importance of t
he duodenal food passage after total gastrectomy. There are a number o
f experimental and clinical studies showing an advantage for the jejun
al interposition between esophagus and duodenum. Others favor the Roux
-en-Y reconstruction, as it is technically less demanding. The purpose
of this study was the randomized comparison between two major reconst
ruction principles after total gastrectomy for gastric cancer (i.e., j
ejunal interposition with pouch versus Roux-en-Y pouch reconstruction)
. A group of 120 patients with gastric cancer were randomized and oper
ated on during a 5-year period according to standardized operative pro
tocols, using either a jejunal interposition with pouch (JIP) or the R
oux-en-Y reconstruction with pouch (RYP). Endpoints of this study were
operation time, intra- and postoperative problems and complications,
patients' body weight, functional assessment, and quality of life. Of
the 120 patients, 14 had to be withdrawn during the operation because
only the Roux-en-Y reconstruction was technically possible. Finally, 5
3 patients with JIP were compared with 53 patients with RYP for the pe
rioperative course. There were no significant differences between the
two procedures (RYP and JIP) regarding complications (24.5% and 26.4%,
respectively), mortality (3.8% and 1.9%, respectively), and operation
time (4.35 hours and 4.40 hours, respectively). For long-term functio
nal comparison 46 (RYP, n = 26; JIP, n = 20) patients were without rec
urrence after 3 years of survival. Comparison of body weight, Visick s
coring, and the Spitzer Index also did not reveal any significant diff
erence between the two operation methods. In conclusion, patients with
gastric cancer after total gastrectomy do not benefit from reconstruc
ting the duodenal food passage by a jejunal interposition with pouch r
egarding their postoperative quality of life when compared to the wide
ly used and technically less demanding Roux-en-Y reconstruction with p
ouch. Differences between the two reconstruction principles, documente
d by sophisticated functional assessment, may well exist, but they hav
e no major clinical importance.