Objective: To determine the optimal digestive tract reconstruction method after total gastrectomy through comparison between the reconstruction with and without jejunal pouch and between the reconstruction with and without preservation of the duodenal passage. Methods: The relevant published literature of randomized controlled trials (RCTs) regarding the reconstruction methods following total gastrectomy was searched, and then systematic review and Meta-analysis for the included studies was performed. Results: Nine RCTs comparing Roux-en-Y reconstruction with and without pouch, and 4 RCTs comparing jejunal interposition with and without a pouch were included for Meta-analysis. In addition, 2 RCTs comparing Roux-en-Y reconstruction alone and with jejunal interposition, and 2 RCTs comparing jejunal interposition with and without a pouch were not applicable with Meta-analysis, but their results were presented as descriptive summary. Results of analysis showed that additional pouch formation versus no pouch did not significantly increase the incidence of perioperative mortality and complications, meanwhile, it significantly reduced the incidence of postoperative digestive tract problems such as dumping syndrome and burning sensation, and offered significantly improved food absorption and quality of life (all P<0.05). Compared with non-preservation of the duodenal passage, no evidence was noted for the benefits of the preservation of the duodenal passage in improvement of digestive tract reactions and quality of life regardless with or without a pouch (all P>0.05). Conclusion: The creation of a jejunal pouch is an effective digestive tract reconstruction procedure after total gastrectomy, while the preservation of the duodenal passage has no obvious advantage.