Parastomal hernia is one of the more common complications of an ostomy (1). Indications for repair include bowel obstruction, incarceration, or enlargement of the hernia to the point where it interferes with maintenance of an appliance and/or if. the hernia is unsightly. Laparoscopic repair is suitable when the patient’s stoma is appropriately sited, the patient lacks a history of extensive adhesions, and their hernia is not too large. Large parastomal hernias are often more appropriately repaired with an open technique. Obtaining good results with underlay mesh usually requires a mesh with at least a 3–5 cm overlap of the mesh beyond the edges of the hernia. This goal is difficult to achieve laparoscopically in patients having large hernias. Another relative contraindication to a laparoscopic approach is the need for an associated open procedure. Both ileostomies and colostomies are suitable for laparoscopic procedures and several techniques of repair have been described (2,3,4,5,6). This chapter will discuss the underlay technique. A similar procedure using an open technique was described by Sugarbaker in 1980 (7). The technique eliminates some of the technical and physiologic problems associated with a “key hole” technique of mesh placement.