Robotic-assisted surgery for parastomal hernia repair: a systematic review and meta-analysis.

To systematically review the current evidence on robotic-assisted parastomal hernia repair (RPHR), evaluating its technical feasibility, safety, and short-term outcomes, with a specific focus on recurrence rates, postoperative complications, and the influence of prior repair history. A systematic review and meta-analysis was conducted following PRISMA guidelines, searching PubMed, Embase, Scopus, Web of Science, and the Cochrane Library. Sixteen studies involving 273 patients were included for qualitative synthesis. Four of these studies, reporting on outcomes based on prior repair history, were eligible for meta-analysis. Key variables included patient demographics, operative metrics, recurrence, and complications. The included studies suggest RPHR is technically feasible, with a low conversion-to-open rate of 0.7%. The pooled data showed a recurrence rate of 5.4% at a short-term mean follow-up of 15 months. This finding must be interpreted with caution, as the brief follow-up period severely limits direct comparisons with open surgery studies, which often report outcomes over longer periods (e.g., 24 months or more). The postoperative complication rate was substantial at 43.0%. This is likely multifactorial, attributable not only to patient-related factors (e.g., mean BMI 28.2 kg/m2) but also to procedural factors, including long mean operative times (230 minutes), institutional learning curves, and the inherent technical challenges of the RPHR procedure. The meta-analysis on the impact of prior repair history was severely underpowered. For recurrence, the analysis of a small cohort (n=25) yielded an inconclusive result with an extremely wide confidence interval (RR=3.02; 95% CI: 0.40–22.76), precluding any definitive conclusions about risk. Therefore, the finding that prior repair history did not increase risk cannot be substantiated. RPHR appears to be a technically feasible approach for parastomal hernia. However, the current evidence, based largely on retrospective studies, is preliminary. The observed 5.4% recurrence rate at 15 months is noted but must be interpreted with significant caution due to the short follow-up. The high 43.0% complication rate warrants further investigation and appears to reflect a combination of patient complexity, procedural challenges, and learning curve effects. The influence of prior repair history on outcomes remains inconclusive due to severely underpowered analyses. Definitive conclusions on the efficacy and safety of RPHR await larger, methodologically rigorous prospective studies with long-term follow-up to provide higher-certainty evidence.