additional Foley balloon catheter is placed in the ostomy to assist with localization of the correct loop of intestine when dissecting adhesions (Fig. 4). An Ioban drape (3M Company, St. Paul, MN) is applied to the abdomen covering the stoma and the inserted Foley catheter. Access to the peritoneal cavity is gained using a Veress needle placed subcostally in the left upper quadrant at the midclavicular line. After adequate pneumoperitoneum (15 mm Hg of carbon dioxide), a 5-mm Optiview port is placed in the lateral position of the abdomen on the side opposite from the ostomy site. On the same side of the abdomen as the Optiview port, two additional 5-mm tro­cars are placed low and lateral in the abdomen. Lysis of any adhesions is performed using sharp dissection. At this stage, external manipulation of the Foley catheter placed in the stoma can greatly help in the identification of the loop of bowel ending in the ostomy. After adhesiolysis is complete, and the entire anterior abdominal wall is visualized with the stomal loop of bowel identified, spinal needles are used to mea­sure the extent of the hernia defect. Any other coexisting ventral hernias are included in the measurement so that all defects are covered (Figs. 5 and 6). The defect is also measured and marked on the outside of the abdomen to later center the prosthesis. A sheet of ePTFE (Gore DUAL-MESH; W.L. Gore, Flagstaff, AZ) is trimmed to a size that allows for 5 cm of overlap beyond all fascial defects. Figures are drawn on the mesh as points of reference for orienting the mesh once placed intra-abdominally. A single Gore-Tex suture (CV-0) is placed at the edge of the mesh on three of the four sides. Two Gore-Tex sutures are placed on the fourth side to allow the mesh to encompass the stoma while allowing the bowel to exit through the created mesh flap-valve. A 5-mm port is placed in the lateral abdominal wall on the opposite side of the three working ports. A 12-mm port is placed in a position where it will later be covered by the mesh to prevent the possibility of trocar site hernia. The superior and inferior edges of the mesh are simultaneously rolled toward one another to facilitate unfurling once in the abdomen. A grasper is placed in the port ipsilateral to the ostomy, and the tip of the instrument brought out through the 12-mm port to grab the mesh and bring it into the abdomen (Figs. 7 and 8). The mesh is unrolled and oriented based on the markings. The open jaws of a laparoscopic atraumatic bowel grasper are used to measure a 5-cm overlap from the edge of the fascial defects (Fig. 9). This area is marked with a spinal needle, and the transfascial sutures are passed through these