Parastomal hernias are complex hernias to manage due to the high risk of recurrence, requirement of a defect in the abdominal wall, and the interaction between mesh and bowel. Multiple operative approaches exist for managing these hernias, which range from a primary repair to a complex abdominal wall reconstruction with retromuscular mesh placement. An open approach to a parastomal hernia is best suited for those with concomitant midline hernias, large (>5 cm) parastomal defects, those that require reciting of the ostomy, or in situations where there is mesh that needs to be removed. Our preferred approach in these situations is an open repair with the development of the retromuscular plane, reinforcement with a medium-weight synthetic mesh with a Sugarbaker configuration of the mesh around the ostomy.