AbstractAimThere are many surgical techniques that deal with external rectal prolapse but perineal procedures have the advantage of reduced invasiveness. Therefore, despite concerns regarding high recurrence rates, the technique is still used by many surgeons.MethodThis manuscript and video describe our early clinical experience using the Harmonic scalpel in 11 consecutive patients who underwent a Delorme's procedure for external rectal prolapse.ResultsThe median age of patients was 76 (range: 30–94) years. There were no intra‐operative complications, and the median operative time was 78 min. Intra‐operative blood loss was minimal (mean 45 ml; range 20–70 ml). Median length of stay was 2 (range: 0–8) days. Overall morbidity and recurrence were both 18%, with a median follow‐up of 15 (range: 1–23) months. Nine patients were operated on by a senior trainee with consultant supervision.ConclusionThe advantages of this device are mainly those of ease of mucosal dissection, minimal blood loss and shorter operative time in comparison with published series.