Available data from follow-up of 183 patients who survived abdominoperineal excision for cancer of the rectum are reviewed. Sixteen patients developed a peristomal hernia, but none required surgical correction for over 20 years of observation. An additional group of 50 long-survivors has been recently examined to verify whether our restrictive surgical indications are adequate. Seven of these patients presented with a hernia, but none suffered obstructive symptoms and surgery was judged unnecessary in every case. Thereby, in our view, the benign evolution of peristomal hernias support a conservative approach based on a confident observation, control of the diseases which increase the abdominal pressure, and hernia compression by a colostomy belt.