Typically, a 20 × 20 cm sheet of biologic mesh is used and positioned in a diamond shaped configuration in the retrorectus and retroperitoneal spaces. The mesh is secured cephalad and caudad initially with two #1 polypropylene sutures brought through the abdominal wall through skin stab incisions with the Reverdin needle. The mesh is then secured later­ally on the side opposite the new stoma, initially with three heavy polypropylene sutures brought transabdominally through the skin stab incisions in the same manner with the Reverdin needle. Keyholes are made in the mesh for passage of the stoma, and the stoma is pulled through; the mesh is resecured with a polypropylene suture laterally to keep the soft biologic mesh just adjacent to the stoma. More recently we have been making a cruci­ate incision in the mesh and pulling the stoma through instead of using keyholes. A small gap of about one finger breadth is allowed adjacent to the stoma to prevent constriction at the mesh level. Again, importantly the hole in the mesh must be made to align with the hole previously made in the posterior sheath. If the rectus muscle, anterior sheath, and skin apertures are not already created, the rectus, anterior fascia, and skin are now pulled toward the midline, so one can determine where a properly aligned aperture can be made for the new stoma site through the remaining abdominal wall. This aperture should be made while simulating the linea alba, reapproximated in the midline. An appropriately sized circle of skin is excised, and a longitudinal, muscle-splitting incision is made in the anterior rectus sheath and rectus muscle. The ostomy is then pulled up through the mesh only. The mesh is then secured in the retrorectus and retroperitoneal spaces to the abdomi­nal wall via three skin stab incisions just as it was on the opposite side (Figs. 7-12 to 7-16).