Background and Aims Parastomal hernia is a common complication after colostomy, with a high incidence rate. Laparoscopic Sugarbaker repair is currently the mainstream surgical approach for treating parastomal hernia. However, compared to other abdominal wall hernia repair techniques, the recurrence rate of parastomal hernia after laparoscopic Sugarbaker repair remains relatively high. Furthermore, the recurrence rate after surgery for recurrent parastomal hernias is significantly higher than that after the initial surgery, with inadequate lateral mesh coverage being one of the major contributing factors. This study was performed to analyze the efficacy of two-point mark-guided laparoscopic Sugarbaker repair in patients with terminal colostomy parastomal hernia, so as to provide evidence-based references for clinical practice.Methods The clinical data of 120 patients with terminal colostomy parastomal hernia, who underwent laparoscopic Sugarbaker repair guided by the two-point mark of mesh at the Department of Hernia and Obesity Surgery, the First Affiliated Hospital of the University of Science and Technology of China, from January 2015 to December 2023, were retrospectively collected. The parastomal hernias were classified according to the European Hernia Society classification. Postoperative symptomatic and radiological recurrence rates were analyzed, as well as the incidence of complications such as bowel obstruction, stoma infection, and intestinal fistula in recurrent and non-recurrent patients.Results Of the 120 patients, 2 (1.7%) were lost to follow-up. The mean follow-up duration was 48 (6-96) months. The postoperative symptomatic recurrence rate was 5.1% (6/118), and the radiological recurrence rate was 6.8% (8/118). There were no statistically significant differences between recurrent (n=8) and non-recurrent patients (n=110) in terms of sex, age, body mass index (BMI), or hernia defect size (all P>0.05), but the operative time in recurrent patients was longer than that in non-recurrent patients (P<0.05). The overall postoperative complication rate was 8.5% (10/118), including stoma skin-mucosa separation (3 cases), stoma infection (2 cases), delayed bowel obstruction (2 cases), early bowel obstruction (1 case), hernia sac effusion (1 case), and delayed fistula formation in the hernia sac cavity (1 case). According to the Clavien-Dindo classification, there were 6 cases of grade Ⅱ, 3 cases of grade IIIa, and 1 case of grade Ⅳ complications. There were no statistically significant differences between patients with and without complications regarding sex, BMI, hernia defect size, operative time, and comorbidities (all P>0.05); however, patients with complications were older than those without (P<0.05).Conclusion The application of laparoscopic Sugarbaker repair under the guidance of two-point mesh identification can effectively reduce the recurrence rate of parastomal hernia and It has high clinical applicability.