Esophagojejunostomy (E-J) can be performed manually or mechanically, as a simple anastomosis or with pouch formation and Y-Roux reconstruction. There is no consensus on which reconstruction is preferable [1].
The simple E-J can lead to increased weight loss, reflux, and dumping syndrome [2]. Pouch formation promotes postoperative food intake and quality of life, but is more frequently associated with reflux symptoms than the classic Y-Roux reconstruction. For this, a sufficient distance between the esophagus and the Y-Roux footpoint anastomosis is required [2].
In long-term survivors, pouch formation is functionally superior to simple Y-Roux reconstruction, as postgastrectomy symptoms are less and the weight course is more favorable [3]. In pouch formation, the anastomosis should lie completely infradiaphragmatically, i.e., intraabdominally.
The end-to-side E-J with Y-Roux should be favored as the technically simplest and fastest reconstruction in cases of overall poor prognosis and is considered the standard technique here due to its simplicity and safety [4].
The mechanical E-J is considered the gold standard with insufficiency rates around 1% [5]. It achieves similar results to hand suturing, but is simpler and faster to perform [6]. The use of stapling devices does not lead to increased safety or reduced complication rate [5]; rather, lack of practice can increase the complication rate, which in turn can be reduced by increased application [7].
Factors promoting insufficiency are tumor location in the cardia area, splenectomy, long operation duration, and manual reconstruction. In anastomosis insufficiencies, increased pathogenic germs could be detected [8].