|Prior to 1990, at our institution, gastrointestinal continuity following distal gastrectomy had been commonly achieved with Billroth I (BI) anastomosis. However in the early 1990s, increase in anastomotic leakage was noted in BI anastomoses, following the introduction of paraaortic node dissection. Since then, we started performing Roux-en-Y (RY) reconstruction after distal gastrectomy to more safe anastomoses.After we experienced more than 3000 cases, we did not observe any leakage cases in gastro-jejunostomy. Duodenal stump leakage was observed in 0.4%. There was no operation related death because of this leakage. Since 2003 we converted hand suturing to mechanical stapling. There were no significant disadvantages of employing mechanical stapling, except for the rather high rate of delayed gastric emptying (J Gastrointest Surg. 2010; 14:289-94). This reconstruction methods has been applied to laparoscopic intracorporeal ansastomosis. Internal hernia is a known complication after this anastomosis, especially when performed laparoscopically. Routine closure of mesenteric space such as Petersen's space is obligatory.Our quality-of-life survey ( int J Clin Oncol. 2007; 12: 433-9) demonstrated that patients were less likely to experience symptoms of either early or late dumping after RY anastomosis than after BI. There were significantly fewer patients with gastritis on endoscopy in the RY group. There was no significant difference in the average relative body weight between the groups. However, patients were more likely to develop gallstones after a RY than after a BI reconstruction.