Incisional Hernia After Minimally Invasive Radical Prostatectomy: A Systematic Review.

Purpose: Incisional hernia (IH) is an under-recognized complication after minimally invasive radical prostatectomy (MIRP). Methods: We performed a systematic review according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to evaluate the proportion, risk factors, and surgical determinants of IH after MIRP. Results: Sixteen studies published between 2010 and 2025 were included, encompassing 56 661 patients. Most were retrospective cohorts, with heterogeneous definitions and diagnostic methods. The reported proportion of IH ranged from 0.04% to 31%, with a median time to diagnosis of 14 mo. Repair was required in up to 80% of cases, and emergency repair in up to 15%. Two comparative studies directly evaluating specimen extraction site consistently reported lower proportions of IH with transverse suprapubic (Pfannenstiel) extraction than with periumbilical extraction, while three registry-based studies similarly reported lower proportions following open compared with MIRP. Evidence regarding the influence of fascial incision orientation on reported IH occurrence was mixed, whereas no clear difference was reported between midline and off-midline extraction sites. Reported factors associated with IH included advanced age, obesity, larger prostate volume, postoperative parietal abscess, and prior abdominal surgery. Limitations include the heterogeneity in the studies included. Conclusions: These findings highlight IH as a clinically meaningful complication of MIRP. Reported IH occurrence differed by specimen extraction site in the available observational studies, but the evidence remains limited by heterogeneous definitions, follow-up, and risk of bias. Preventive strategies, including the site of specimen extraction, warrant further prospective evaluation.