With the widespread use of low anal preservation techniques, permanent colonic stomas are much less common than in the past, but they are still a frequently chosen procedure for low rectal cancer. Permanent stomas from the Miles procedure currently account for only about 10% of rectal cancer surgeries. There are many complications arising from the stoma, including stoma hernia, which is a complication that does not resolve spontaneously. Clinically, stoma hernia is generally divided into two types: one type is colonic condylomatous prolapse, which can be divided into simple prolapse and incarcerated prolapse according to the different degree of prolapse, which occurs more in ileocecal and transverse colonic stoma because the proximal intestinal tube is more free, and it occurs in the sigmoid colon relatively less, especially in extraperitoneal stoma; the other type is herniated outward with complete intact stoma, which occurs in the weak gap between stoma and the abdominal fascial muscular ring. The other type is herniated outward with a complete hernia sac, which is the common clinical parastomal hernia, and the herniated content can be the colon proximal to the stoma or other abdominal contents. There are many reasons for parastomal hernia, such as too large and loose opening of abdominal wall stoma, weak abdominal wall fascia muscle, intra-abdominal high pressure caused by frequent coughing and constipation, etc., and one of the important reasons may be that the connection between abdominal wall and colon is not dense enough and the defect of the abdominal wall fascia muscle ring at the stoma to fight against the intra-abdominal tension, and almost all of parastomal hernias have such a pathologic feature, that is the enlargement of the abdominal wall fascia muscle ring. Therefore, the prevention of postoperative tense enlargement of the abdominal wall fascia muscle ring is an important consideration in stoma surgery. In more than one hundred years of colostomy history, many scholars have tried to improve the stoma method to reduce stoma complications, such as magnetic device stoma, poly-silicone ring stoma, colonic smooth muscle transplantation stoma, etc. Most of them could not be popularized due to complicated operation or materials, or were eliminated due to more complications, but these explorations still provide a lot of experience and inspiration for the future generations. In order to prevent the occurrence of parastomal hernia, measures are currently taken in the following aspects. I. Selection of stoma site Selection of an area that can have a relatively intact musculofascial ring of the abdominal wall is an important surgical choice. At present, there is not a unified anatomical standard for the selection of stoma site, because the patient’s physical condition, occupation and trouser-belt habit are also taken into account, but there is a problem that can reach a consensus, that is, the abdominal wall around the periumbilical region and its fascial muscular stoma ring relative to the other abdominal wall areas to be intact and solid, in this part of the stoma, the chances of parastomal hernia are much less than in other places, and this area is generally more elevated, and it is also convenient for the occurrence of parastomal hernia. In addition, this area is generally more elevated, which makes it easier to attach and care for the stoma bag. The permanent colostomy points applied in the clinic are as follows: (1) 3-5 cm below the umbilical level and 3-5 cm to the second side of the abdominal midline; the stoma in this area can be hidden in pants, with the disadvantage that it is inconvenient to take care of the stoma. (2) flat umbilicus, about 4-5cm lateral to the umbilicus, this area of the stoma in the pants above the belt care is convenient, the disadvantage is not hidden enough; (3) umbilicus on the 4-5cm, generally used for transverse colostomy. In the clinical application of more transverse colostomy and sigmoid colostomy, so the stoma point is generally in the umbilicus, the left side of the umbilicus and umbilicus in the left lower region, in these areas of the stoma channel is generally solid rectus abdominis muscle anterior and posterior sheaths or rectus abdominis muscle and the chance of hernia adjacent to the stoma is less than the traditional left, the right lower abdominal stoma through the internal and external abdominal obliquity muscle. Second, the establishment of appropriate abdominal wall stoma channel Different parts of the stoma, the abdominal wall stoma channel of the muscle ring structural level is different, tensile strength is also different. After selecting the stoma site, the establishment of a suitable stoma channel is also a very important technical factor, which mainly includes the diameter size of the stoma and the establishment of the abdominal wall myofascial ring. The size of the stoma depends, on the one hand, on the thickness of the intestinal tube itself and whether the stoma is a single- or double-lumen stoma, and, on the other hand, on the size of the skin incision for the stoma and the size of the fascial muscle ring. To optimize the size of the stoma, it should be handled according to the patient’s specific situation. The general principle is to excise a circular skin at the determined stoma site, the diameter of which is slightly smaller than the diameter of the intestinal tube to be pulled out of the stoma, by lifting the skin with tissue forceps, making a circular incision of about 2-3 cm in diameter, and excising it together with the subcutaneous tissues. In order to do this well, inexperienced people can first cut a relatively small circle, which will be enlarged as soon as it is pulled out, and then cut a portion of the incision if they find it insufficient, so that a smaller circle than that inadvertently appears. This will avoid the inadvertent appearance of a stoma hole that is much larger than the bowel; too large a hole will cause excessive tension on the skin margins and the stoma flap bowel suture, which may lead to separation of the mucosa and skin after the operation. Thin people do not need to remove the subcutaneous tissue, along the incision can be cut, obese people need to remove more subcutaneous fat tissue, in order to drag the fat intestinal tube out of the stoma. Establishment of fascial muscle ring: generally along the direction of the muscle texture for the “one” incision, can also be used for the “ten” incision, but be careful not to be larger than the skin incision, longitudinal blunt separation of the muscle bundles in the same area, the caliber of the intestinal tubes need to be dragged out of the appropriate, about 3 fingers through the patient, the caliber of the intestinal tubes need to be dragged out of the stoma, and then the intestinal tubes can be removed. The caliber of the muscle is appropriate to the diameter of the bowel to be dragged out, which can be passed through about 3 fingers of the operator. If the rectus abdominis muscle is too hypertrophied, the forceps can be used to pick out part of the muscle cord to be cut off, and then incise the posterior sheath of the rectus abdominis muscle, and decide to choose a peritoneal incision or an extraperitoneal tunnel enterostomy. The thin intestinal tube, intestinal periphery and mesenteric adipose tissue is less, the caliber of the stoma is relatively smaller, the obese intestinal periphery and mesenteric adipose tissue is more, the caliber of the stoma should be larger. Third, peritoneal incision or extraperitoneal tunnel stoma selection Traditional enterostomy using direct peritoneal incision, stoma intestinal tubes around the peritoneal cut edge with suture fixation, interrupted or continuous suture closure of the intestinal tubes and the side of the peritoneum of the gap, ileostomy, transverse colonic stoma is generally still the choice of this traditional stoma. Permanent sigmoid colostomy can use extraperitoneal tunnel stoma: choose the appropriate location of blunt separation of the lateral peritoneum until the peritoneum and abdominal wall stoma at the rendezvous, the intestinal tubes to be stoma through the extraperitoneal tunnel and the abdominal wall stoma dragged out, check the intestinal tubes, the mesentery is not torsion, the tightness of the appropriate, intestinal tubes with a good blood supply, will be unfolded on the side of the peritoneum, to prevent rolled up into the fascia oppression of the intestinal tubes. The advantages of extraperitoneal tunnel enterostomy are: (1) it will not cause small intestinal hernia due to poor closure of the lateral peritoneal suture; (2) it is not easy to retract the intestinal tube of the stoma; (3) it will not prolapse the intestinal tube of the stoma; (4) it is not easy to herniate next to the stoma; (5) it is easy to operate the surgery. With the development of artificial materials in recent years, some people use artificial materials or biomaterials to reinforce the stoma channel to prevent parastomal hernia, although the long-term effect is yet to be observed, but the preliminary short-term results show that it has a good preventive effect.