Purpose: Different techniques and mesh materials are used in parastomal hernia repair with recently reported recurrence rates ranging from 10 to 28%. The aim of this cohort study was to examine the risk of recurrence and chronic pain after Sugarbaker or keyhole parastomal hernia repair with intraperitoneal placement of a polyester monofilament macroporous composite mesh. Methods: Data on all patients undergoing parastomal hernia repair with Parietex™ Composite Parastomal Mesh at our institution during a 4-year period were examined. Patients with urostomy were excluded. A team of three experienced surgeons performed all repairs. Follow-up including physical examination was done after 10 days, 6 and 12 months, and hereafter as annual structured telephone interviews. Patients suspected of hernia recurrence were offered computed tomography scan. Chronic pain was defined as pain requiring out-patient visit(s) and/or regular use of analgesics. Results: 79 patients (Sugarbaker, n = 69; keyhole, n = 10) were included. Of those, 72 procedures were performed laparoscopically and seven by open technique. Two patients were reoperated within 30 days with removal of the mesh. In total, seven (9%) patients had parastomal hernia recurrence (reoperation, n = 3; conservative management, n = 4) during follow-up of median 12 months (range 0–49 months). In univariable logistic analyses, type of stoma was associated with recurrence (ileostomy 28% vs colostomy 3%, p = 0.007). Three patients (4%) reported chronic pain. Conclusion: In this study, we found low rates of recurrence and chronic pain following parastomal hernia repair using intraperitoneal reinforcement with a polyester monofilament composite mesh.