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Parastomal herniae are common and a degree of herniation/prolapse may be inevitable. This study assesses the success of hernia repairs in relation to stoma site within the abdominal wall (within rectus sheath versus lateral to rectus sheath).A retrospective review of clinical outcomes following operative intervention was performed. Herniae were repaired via a lateral approach, with on-lay placement of porcine dermal collagen mesh (PermacolTM, and country.).Twenty seven patients (15 female, 12 male) with parastomal hernia repaired utilizing porcine dermal collagen (PermacolTM) were identified from July 2007 to October 2009. 20/27 had a colostomy and 7/27 had an ileostomy. Eleven patients were found to have a stoma traversing the rectus abdominis sheath: 16 were lateral to the rectus sheath. When the stoma traversed the rectus sheath 2/11 patients had recurrence. When the stoma was lateral to the rectus sheath 11/16 patients had recurrence (P = 0.018). One patient developed an abscess. No complications related to porcine dermal collagen (PermacolTM) occurred.Repair of parastomal herniae lateral to the rectus sheath is not recommended. Resiting the stoma should be considered in these cases. For defects within the rectus sheath, porcine dermal collagen (PermacolTM) on-lay repair gives good results.