Gastric cancer is worldwide one of the most common causes of cancer death. Operation is the only treatment at this time that cures some patients. The side effects of the operation are, however, considerable, and include postoperative weight loss, loss of appetite, and other metabolic and nutritional changes. The recovery is very slow and incomplete. Reconstruction with different types of pouches has been asserted to facilitate the nutritional recovery, but results from different studies are somewhat contradictory. Malnutrition, osteoporosis, osteomalacia, and impaired quality of life are often but not always described. We can, however, establish that after a total gastrectomy, gastric cancer patients are very much at risk for these complications, which are probably caused by impaired food intake and steathorrhea even when the patients are cured from their cancer disease. In order to minimize the nutritional problems, it is crucial to avoid anastomotic narrowing and bile reflux. Roux-en-Y reconstruction seems to be the method of choice. Evidence from several randomized studies now speak in favor of including some type of pouch in the reconstruction. The most commonly used pouch today is the jejunal J-pouch. How the effect is exerted is not clear. Probably both the reservoir function of the pouch and changes in intestinal transit time are important. The importance of nutritional surveillance of these patients should not be underestimated, and most of the observed differences from various reports are probably due to dissimilarity in the follow-up protocols. A patient surviving his/her cancer has a decreased risk of developing severe disturbances in bone metabolism, food intake, body composition, and quality of life if the patient is under concerned nutritional surveillance and reconstructed with a pouch.