Parastomal hernias are relatively common sequelae of stoma creation. They can lead to life-threatening complications and are difficult to repair. The best treatment is through prevention at the primary operation. Technique used at the initial surgery is important, but the technical details of optimal stoma creation have not been clearly delineated. There is a growing body of literature that supports the safety and efficacy of placing prophylactic mesh at the original operation, including several prospective randomized trials. The literature and the various techniques of creation will be reviewed in this article.