Demonstrate a laparoscopic Sugarbaker technique for parastomal hernia repair using Gore Tex mesh. An 18 year old male with a history of anal cancer status post abdominoperineal resection with an end colostomy and known chronic parastomal hernia. His history also includes hypoplastic left heart syndrome status post orthotopic cardiac transplant, DiGeorge syndrome, Hodgkin's disease type post-transplant lymphoproliferative disease, and immune deficiency. He presented with abdominal pain, nausea, and vomiting secondary to small bowel obstruction at the site of his previous parastomal hernia. CT scan showed a mesenteric swirl with a transition point. Upon laparoscopy, the parastomal hernia was identified. The bowel was reduced and hernia edges cauterized. Primary repair of the hernia defect was performed using a percutaneous technique. A JP drain was left inside the hernia area and exited through a separate part of the abdomen. Following the Sugarbaker technique, a 16 by 20 cm Gore Tex-dual mesh plus was used to reinforce the defect. Percutaneous sutures in the four corners secured the mesh. Once the mesh was in the desired location, absorbable tackers were used to attach the mesh to the anterior abdominal wall. Additional percutaneous sutures were added to the medial mesh. The patient recovered well. His NG tube was removed on post-op day 4, he was advanced to regular diet and discharged on post-op day 7. Surveillance CT showed intact repair with no recurrence a year after surgery. This case demonstrates a Sugarbaker technique for closure of parastomal hernias using Gore Tex graft for parastomal hernias.