Esophagojejunostomy (E-J) may be fashioned Roux-en-Y by hand or mechanically as a simple anastomosis or with pouch formation. There is no consensus as to which technique is preferable [1].
The simple E-J may result in increased weight loss, reflux and dumping syndrome [2]. A pouch promotes better postoperative food intake and quality of life but is more frequently associated with reflux symptoms than the classical Roux-en-Y procedure. This requires adequate distance between the esophagus and the jejunojejunostomy [2].
In long-term survivors the pouch procedure is functionally superior to simple Roux-en-Y reconstruction, since postgastrectomy symptoms are less severe and weight progression is more favorable [3]. When fashioning the pouch, the anastomosis should be completely subphrenic, i.e., within the abdominal cavity.
In patients with poor overall prognosis, the end-to-side Roux-en-Y E-J should be favored as the technically simplest and fastest reconstruction and, due to its simplicity and safety, in these situations it is regarded as the standard technique [4].
With failure rates around 1% the mechanical E-J is regarded as the gold standard [5]. It has similar results as the hand sewn anastomosis but is easier and faster to perform [6]. Staplers do not increase safety or reduce complication rates [5]; on the contrary, lack of practice may increase the complication rates, which in turn may be reduced by increased volume of this procedure [7].
Cardiac tumors, splenectomy, long operating times and manual anastomosis may increase anastomotic failure. Pathogenic organisms have been demonstrated more often in anastomotic failure [8].