Prostate cancer is a common malignancy in men, and robotic-assisted radical prostatectomy (RARP) is widely used for its treatment. Inguinal hernias (IH) frequently coexist in this population, with up to one-third diagnosed before or during surgery. Concurrent inguinal hernia repair (IHR) during RARP offers a chance to reduce the need for separate operations, though concerns remain regarding mesh-related complications. Minimally invasive techniques such as robotic TAPP and TEP have shown promising outcomes with low complication rates and minimal added operative time. This systematic review and meta-analysis aims to evaluate the safety and efficacy of concurrent IHR during RARP.

A systematic review was performed in accordance with PRISMA guidelines, and the protocol was registered with PROSPERO (CRD42025646245). Searches of PubMed, Embase, CENTRAL, and grey literature identified studies reporting outcomes of concurrent robotic radical prostatectomy and inguinal hernia repair. Inclusion criteria comprised prospective or retrospective studies with reported safety and efficacy outcomes. Pooled proportions were calculated using a random-effects model and meta-analysed. Risk of bias was assessed using a modified Newcastle-Ottawa scale.

A total of 20 studies were included in the meta-analysis, comprising 1,130 patients who underwent concurrent inguinal hernia repair during robotic-assisted radical prostatectomy and 21,429 control patients who underwent RARP alone. Baseline demographics, including mean age (63.6 years vs 62.2 years) and body mass index (BMI) (27.1 kg/m² vs 27.3 kg/m²), were comparable between the intervention and control groups. Patients undergoing concurrent IHR experienced a statistically significant increase in intraoperative blood loss (mean difference: 22 mL; 120 mL vs 98 mL, p < 0.00001), operative duration (mean difference: 8 minutes; 199 minutes vs 191 minutes, p < 0.00001), and postoperative length of stay (mean difference: 0.9 days; 2.1 days vs 1.2 days, p < 0.00001). The pooled recurrence rate for inguinal hernia following concurrent repair was 1%. There were no statistically significant differences in postoperative complications between groups across Clavien-Dindo grades: grade I (6% vs 7%, p = 0.35), grade II (14% vs 15%, p = 0.76), or grade III (1% vs 2%, p = 1.00).

Concurrent inguinal hernia repair during robotic-assisted radical prostatectomy is a safe and feasible approach, with low recurrence and comparable rates of postoperative complications to RARP alone. While there is a modest increase in operative time, blood loss, and length of stay, these differences are statistically significant but likely clinically acceptable in appropriately selected patients. The findings support the integration of concurrent IHR into routine practice where indicated, potentially sparing patients a second operation. Further prospective, high-quality studies are warranted to validate long-term outcomes and standardise surgical techniques.