Total gastrectomy and reconstruction

During total gastrectomy, the stomach is removed from the esophagogastric junction to the proximal duodenum (past the pylorus) as depicted by the shaded area in A. Gastrointestinal continuity is restored using a Roux limb of small bowel (C), which is anastomosed to the esophagus in an end-to-side fashion, with or without the creation of a pouch, or neostomach (B).