**4. Methods – surgical technique: esophageal mucosectomy**

Surgical technique following standardization proposed by Aquino [65]:

a.Mucosal resection - Abdominal stage: The surgery starts with a midline laparotomy from the xiphoid process to 5 cm below the umbilicus followed by dissection of the abdominal esophagus and division of vagi nerves. Longitudinal myotomy in the anterior esophagus from the cardia to the hiatus and circumferential dissection of the mucosa/submucosa layer in 5 to 7 cm (**Figure 1**).

Cervical stage: Left lateral cervicotomy following the anterior border of the sternocleidomastoid muscle from the sternum to 10 cm upwards. Dissection of the esophagus free of the posterior and prevertebral fascia and trachea. Longitudinal myotomy in the anterior esophagus 5 cm from the pharynx to the sternum and circunferencial dissection of the mucosa/submucosa layer. (**Figure 2**).

Combined stage: After a cylindrical segment of mucosa is dissected free of the muscular in the abdomen and neck, a small mucosectomy is made in the abdomen and neck to allow the passage of a rectal tube upwards. Cervical esophageal mucosa is circumferentially transected and tied to the rectal tube by a long and resistant surgical thread to allow pulling the replacement viscera to the neck. The mucosa is slowly striped downwards and inverted in the abdomen. (**Figures 3** and **4**). The esophagus is completely sectioned at the level of the esophagogastric junction and the neck.

b.Digestive Tract Reconstruction: Digestive tract was reconstructed in all patients with the stomach after division of the left side gastric, right gastroeplicoic and

**Figure 1.** *Abdominal stage-circunferencial dissection of the mucosa/submucosa layer.*

**Figure 2.** *Cervical stage-circunferencial dissection of the mucosa/submucosa layer.*

short vessels. A route for stomach transposition on accessibility to the neck in all patients was into the muscular tunnel (**Figure 5**). Esophagogastrostomy anastomosis was performed at the cervical level too in all patients with a circular stapler for end-to-side anastomosis. A feeding jejunostomy tube was always added to the procedure. Drains were left in the abdomen and neck.
