An alternative approach to reconstruction after proximal two-thirds gastrectomy for benign disease involves proximal gastric vagotomy and interposition of a jejunal segment between the esophagus and antrum. This permits preservation of pyloric function and avoids reflux esophagitis. The latter can also be circumvented by interposing a jejunal segment between the esophagus and antrum in the course of an esophago-proximal gastrectomy for a malignant condition.