How to do a Delorme's sleeve mucosectomy and muscular plication for full-thickness rectal prolapse

Figure S1: Table positioning for the prone jack-knife position. Pillows are placed beneath the chest, hips and knees to prevent pressure injuries and to optimize access to the perineum.

Figure S2: The buttocks are retracted using and elastic adhesive bandage by placing an initial strip in a craniocaudial orientation followed by an additional strip which is secured to the rails of the bed.

Figure S3: Elastic stays placed just above the level of the dentate line to aid in visualization.

Figure S4: The rectal mucosa is grasped with two Rampley forceps and gentle traction is applied until no further tissue can be exteriorised. These are then used to maintain retraction throughout the procedure. The rectal mucosa is scored circumferentially with diathermy 1 cm above the dentate line.

Figure S5: A dilute solution of methylene blue and adrenaline is injected in the submucosal plane allowing clear delineation between the submucosa which will be stained blue and the muscularis propria which will appear white, as well as elevating the mucosa to aid in dissection and providing haemostasis.

Figure S6: The dissection is started laterally using electrocautery to develop the submucosal plane. Alice forceps are used to grasp and retract the mucosal edge.

Figure S7: At the apex of the prolapse the dissection is continued inwards. Methylene blue can be seen staining the submucosa clearly delineating the dissection plane.

Figure S8: 2–0 PDS plication sutures are placed starting internally at the mucosa and continuing to the mucosa above the dentate line. Care must be taken while placing full thickness muscular bites to prevent picking up the internal muscular layer.

Figure S9: The untied sutures are secured with artery forceps and the operative field is irrigated with dilute betadine solution.

Figure S10: The elastic stays are removed and 2–0 PDS sutures are tied sequentially.