Parastomal hernias remain a daunting challenge to general and colorectal surgeons. Their unique anatomy and alteration of abdominal wall mechanics contribute to a significant recurrence rate and associated morbidity in repair. Recent advances in synthetic and biologic meshes, as well as refinement of laparoscopic surgical techniques, may offer potential improvements in outcome for these patients. We conducted a review of the literature for parastomal hernia repair, including manuscripts specifically addressing the use of synthetic and biologic prostheses. We then chose selected references from these studies to include in this review. Results are summarized to reflect current evidence for use of prostheses and other techniques in the repair of parastomal hernias. Repair of parastomal hernias remains plagued by significant recurrence rates. Recurrence may be higher when other abdominal wall hernias are addressed simultaneously. Synthetic mesh repair appears to reduce recurrence compared with primary suture repair. The use of biologic prostheses may reduce recurrence rate and eliminate the potential for mesh infection. The laparoscopic approach should be individualized to both patient and surgeon factors.