Reconstruction of the digestive tract after total gastrectomy should be safe and give the patient maximal comfort. Dehiscence of the esophago-enteral anastomosis is the main cause of operative mortality. Stapling and jejunoplication procedures offer the best chances of success. A Roux-en-Y esophagojejunostomy is readily carried out in patients with malignant disease, and avoids distressing reflux esophagitis, which constitutes a major cause of morbidity. The construction of a gastric reservoir has been advocated to prevent malnutrition, weight loss and other functional complaints. This matter is still the subject of much debate and requires further prospective studies. A personal retrospective evaluation of 23 patients provided with a Lygidakis pouch after total gastrectomy shows that this procedure can be performed with an acceptable mortality rate (8.7%). The clinical results look promising as most of the patients studied one year after the operation had no functional complaints and their weight had stabilized.