The long-term recurrence rate after parastomal hernia repair remains high, and its influencing factors are still controversial. To provide evidence-based support for optimizing clinical decision-making, we systematically searched databases such as PubMed, Embase, Cochrane Library, and CNKI for relevant clinical studies from the establishment of the databases to February 2026. The quality of the literature was assessed using the Newcastle-Ottawa Scale (NOS), and Meta-analysis alongside qualitative systematic review was performed using R software. Four high-quality studies comprising 542 patients were included. Meta-analysis demonstrated that compared with the Keyhole technique, the Sugarbaker technique showed a significant clinical advantage in reducing long-term recurrence risk (OR=0.58, 95% CI 0.26-1.27). Further analysis indicated that patient systemic metabolic status (such as obesity with body mass index ≥30 kg/m², diabetes, and advanced age) and inflammatory bowel disease were core independent risk factors for postoperative recurrence. Furthermore, severe short-term complications like surgical site infection and seroma significantly increased the long-term recurrence rate. In conclusion, selecting a biomechanically superior repair technique (e.g., Sugarbaker) and strictly managing perioperative weight, glycemic control, and infection prevention are crucial strategies to minimize the risk of parastomal hernia recurrence.