Fig. 1

Surgical procedure of right-sided overlap and single-flap valvuloplasty. A Two internal organ retractors were clipped to right and left diaphragmatic crura. B A 3.0 × 3.5 cm “匚”-shaped region was marked with methylene blue, 1.5–2.5 cm distal to transection line of the stomach. Diluted methylene blue was injected submucosally. C A left-sided flap was made by cutting between submucosa and muscular propria with an electric scalpel. D Posterior esophageal wall was fixed with anterior gastric wall using a barbed suture. E A linear stapler was inserted into the openings of the stomach and esophagus to perform side overlap anastomosis. F A second barbed suture was used to close the common opening. The lower edge of the esophageal stump was fixed by two interrupted sutures. G The distal brim of the flap was sutured using the second barbed suture. An interrupted suture anchored the flap on upper-right corner. The proximal and right brim of the flap were sutured using the first barbed suture. H Final shape of the single flap