Abstract： Objective To investigate the optimal reconstruction technique after total gastrectomy. Methods A total of 159 patients with gastric cancer undergoing total gastrectomy in Tianjin Cancer Hospital between January 2005 and December 2007 were divided into 4 groups according to the reconstruction technique: group A (functional jejunal interposition with a pouch, n=46),group B (modified Braun type Ⅱ , n=38), group C (P pouch with Roux-en-Y esophagojejunostomy, n=25 ),group D(Roux-en-Y esophagojejunostomy,n=50). Quality of life(QOL), nutritional status 1 year after surgery, and perioperative complications were analyzed. Results There were no significant differences in perioperative complications (P＞0.05). One year after operation, QOL (Visick index) was better in group A than that in group B, C and D (P＜0.05), and group D was inferior to group A, B and C(P＜0.05). The increase in food intake, weight gain, hemoglobin and total protein were better in group A than those in group B, C and D(P＜0.05) and group D was inferior to group A, B and C(P＜0.05).The prognostic nutrition index ratio of the four groups were 1.21±0.15, 1.14±0.97, 1.15±0.16, and 1.10±0.16, respectively. Group A was better than that in group B, C and D (P＜0.05) and group D was inferior to group A, B and C (P＜0.05). The incidences of dunping syndrome, reflux esophagitis,Roux-en-Y stasis syndrome in group A were 4.3%(2/46), 2.2%(1/46) and 2.2%(1/46), respectively,which were significantly lower than those in other groups (P＜0.05). Conclusions Functional jejunal interposition with a pouch is associated with improved nutritional condition and quality of life, and less perioperative complications. It is a reasonable reconstruction method after total gastrectomy.