Stoma are necessary for a number of elective and emergent gastrointestinal and urological procedures and may or may not be permanent. Parastomal hernias (PH) are prone to occur given the existing fascial defect on the abdominal wall and pose a challenge for repair with their lateral location, which makes it difficult to achieve large mesh overlap. In this chapter, we review the current evidence in minimally invasive hernia repair and discuss operative techniques. Specifically, we detail our preferred approach to PH repair, which is a robotic modified (preperitoneal) Sugarbaker technique. Robotic PH repair has a number of advantages over open repair and when compared to a laparoscopic repair, dissection, fascial closure, and mesh positioning, especially in the preperitoneal or retrorectus plane, are easier to perform. Furthermore, newer techniques for operative management are discussed along with methods of preventing PH, such as prophylactic mesh placement.