Chimney Trial of Parastomal Hernia Prevention

Inclusion Criteria:

* 18 years or older
* Rectal adenocarcinoma with curative intent laparoscopic or robotic assisted abdominoperineal resection or low Hartmann´s operation and permanent colostomy
* Patient has a life expectancy of at least 12 months.
* Patient must sign Informed consent before any study procedures and agrees to attend all study visits

Exclusion Criteria:

* Abdominoperineal resection or Hartmann's operation by laparotomy or conversion to laparotomy
* Complication requiring laparotomy during post surgery treatment at surgical ward after APR
* Patient with a comorbid illness or condition that would preclude the use of surgery (ASA 4-5).
* Patients with concurrent or previous malignant tumors within 5 years before study enrollment
* Patients with T4b tumors which impose a multi-organ resection
* Rectal malignancy other than adenocarcinoma
* Patient undergoing emergency procedures
* Planned rectal surgery along with major concomitant procedures (e.g. hepatectomies, other intestinal resections).
* Metastatic disease with no possibility of curative surgery
* Pregnant or suspected pregnancy
* Patients living geographically distant and/or unwilling to return for follow-ups or comply with all study requirements
* Active abdominal infection at the time of surgery
* Previous surgery at the colostomy site
* Language barrier or other reasons why informed consent is not possible