**2. Reconstructive procedures after total gastrectomy**

## **2.1. Concept of reconstructive procedures after total gastrectomy**

During the first successful TG in 1897, Schlatter reconstructed the digestive tract by creating end-to-side esophagojejunostomy [2]. Many of the pioneers of TG performed reconstruction with esophagoduodenostomy or formed loop esophagojejunostomy [7, 9]. High operational risk and frequent malnutrition observed during the postoperative period gave TG an unfavorable reputation. The loop esophagojejunostomy technique was modified by Hoffman in 1922. He added a small side-to-side jejunojejunostomy between two ends of the jejunum loop [10]. This provided partial bypass to the duodenal content and reduced the frequency of alkaline reflux esophagitis. The major immediate postoperative problem after TG concerned the integrity of anastomosis on the esophagus. Later postoperative problems were associated with reconstruction and nutritional status and quality of life that is more affected by the aspects of reconstruction than the anastomosis on the esophagus itself.

To date, more than 60 different reconstructive procedures (RP) of intestinal reconstructions have been described after TG which were, and are now, in use in surgical institutions [11, 12]. The main modalities of reconstruction after TG are restoration of intestinal continuity, without preserving duodenal passage (DP) of food (esophagojejunostomy with RY configuration) and restoration of intestinal continuity with the preservation of DP (esophagojejunostomy with RY configuration and formation of side-to-end jejunoduodenostomy double tract (DT) and Longmire's longitudinal interposition). Operations in these categories can be combined with the formation of an enteral pouch or a gastric reservoir that simulates the function of the reservoir of the normal intact stomach. The RP with pouch and neo-stomach formation have been developed to provide food tanks, with the goal of preserving duodenal transit and providing the anatomy and physiology of the digestive tract. Advantages and disadvantages of these RP continue to be the subject of discussion due to the existence of contradictory results from various studies.
