Forty-nine gastric carcinoma patients were randomized after total gastrectomy to the Hunt-Lawrence pouch reconstruction (pouch group, 26 patients) or to the Roux-en-Y reconstruction without pouch (control group, 23 patients). Mortality, morbidity, and the quality of life during 24 months were determined. The operative mortality was zero. The total complication rate was increased in the pouch group as compared with the control group (65 vs. 35%; p = 0.03). The clinical anastomotic leakage rate was not significantly different between the groups. Operation time, blood loss, or survival did not differ between the groups. Both the reported and measured eating capacities were significantly better, and postprandial early satiety and dumping were significantly less frequent in the pouch group than in the control group.