Mesenteric molding suturing significantly reduces parastomal hernia rates after colostomy, presenting a safer alternative with fewer complications.

• Parastomal hernia incidence was 19.8% in the molding group, compared to 27.6% in controls (p < 0.001).
• Molding suturing reduced the risk of hernia by 32% (hazard ratio 0.68, p = 0.02).

MMS slightly increased operative time but did not raise blood loss or complication rates. Consider MMS for elective colostomies to lower hernia risk without added surgical complexity.