|Distal gastrectomy is a surgical procedure typically performed for gastric cancer as well as for pyloric cancer, which is a common site of gastric cancer, and can also be performed for cancers of the gastric body, if permitted by the resection margin with the gastric cardia, although gastric remnants become smaller. Reconstruction methods include the Billroth I method (B-I) and Roux-en-Y method (RY), both of which are widely used. There is controversy regarding the choice of methods due to a lack of clear evidence. At our hospital, RY is essentially chosen as the reconstruction method for open distal gastrectomy (ODG) and laparoscopic gastrectomy (LAG).Major advantages of RY are that it has wide applicability with little postoperative reflux symptoms. RY is well suited for elderly and obese patients, who are expected to increase in numbers in the future, as well as for patients with cancers of the upper stomach. We report on the postoperative endoscopic findings using a questionnaire survey of symptoms comparing RY and B-I in ODG. Patients who underwent RY reported less esophagitis and inflammation of the gastric remnant, no differences in the incidence of dumping syndromes, and only mild symptoms, such as congestion. To optimize this procedure, we prevented postoperative complications by covering the duodenal stump, closing Petersen's defect, and closing the mesentery of the Y anastomosis site, thereby enabling smooth elimination from the stomach through reversed peristalsis gastrojejunostomy and suturing. Furthermore, the Y anastomosis site can cause adhesion; therefore, the mesentery is placed to face dorsally.In various clinical trials, including randomized controlled trials, short-term outcomes of RY have been poorer than those of B-I; however, reports from reputed institutions indicate good short-term outcomes. Moreover, postoperative Petersen hernias and duodenal stump fistulas have been reported; however, we believe that they can be prevented by the previously mentioned countermeasures.