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Parastomal hernias (PH) are frequent with a high morbidity. Three randomised controlled trials showed that mesh reinforcement significantly reduced their incidence. The techniques however were time consuming, difficult to perform laparoscopically and relied on manual stretching of the trephine. SMART obviates theseproblems.SMART uses a purpose designed circular stapling gun (CompactTM) to create aprecise trephine in the posterior rectus sheath and peritoneum and simultaneously fixes mesh sub-peritoneally and circumferentially to the trephine. Stretching is minimised. Nine patients (M:F 2:7 Median age 55 years range 24-77) at high risk of PH and in whom randomisation in a controlled trial was contraindicated underwent SMART (seven open: two laparoscopic).There was no post operative (30 days) morbidity related to stoma formation. All stomas functioned satisfactorily within 48 hours. One patient developed intestinal obstruction after hospital discharge unrelated to stoma formation and another developed temporary peri-stomal pain and swelling following successful cardiorespiratory resuscitation. During FU of 13 weeks (2-14) no parastomal hernia was found.SMART is a new and simple means ofprecisely creating a reinforced stoma trephine at both open and laparoscopic surgery. It should reduce the parastomal herniation rate but randomised controlled trials are needed.