Recently, total gastrectomy has been increasingly used for gastric cancer. However, it remains controversial as to the optimal technique for reconstruction after total gastrectomy. As of now, more than 70 reconstruction techniques following total gastrectomy have been reported, and each model has its own merits and demerits. Currently no ideal digestive reconstruction exists. The cores of these controversies are how to improve the postoperative quality of life on the basis of oncological and operative safety. The controversies focus on the following three aspects: (1) necessity of physiological duodenal passage; (2) necessity of a gastric pouch; (3) the optimal pouch configuration. Evidence-based medicine with large sample, multicentric, prospective randomized control trials is warranted.