Gastric cancer is a common malignant tumor in the digestive system. Total gastrectomy is an important treatment method for advanced gastric cancer. Postoperative digestive tract reconstruction is a key part of the surgery, and the choice of the method directly affects the prognosis and quality of life of the patients. There are numerous methods for digestive tract reconstruction after total gastrectomy. Although most patients can restore basic digestive functions through reasonable reconstruction methods, or only experience mild digestive discomfort, which can be improved through postoperative adjustment, when patients suffer from severe complications such as malnutrition, refractory reflux, and anastomotic fistula, the treatment plan often needs to be adjusted or re-surgery is required. The surgical reconstruction methods mainly include Billroth-I anastomosis, Billroth-II anastomosis, and Roux-en-Y anastomosis, etc. This article aims to analyze the advantages and disadvantages, clinical application effects, and applicable scopes of each method, in order to provide a reference basis for the selection of clinical surgical methods.