Abstract: Surimi products are favored by consumers due to their high nutritional value, product diversity, and convenience. However, with the advancement of industrial processing technologies and the growing demand for dietary diversification, traditional surimi products are no longer able to meet the evolving needs of the industry. Inoculated fermentation technology has emerged as an important research focus in the field of aquatic product processing, as it regulates the textural properties, flavor profile, and functional value of surimi products through microbial metabolic activities. This review synthesizes existing studies, with particular emphasis on the regulatory effects of different starter cultures—such as Lactobacillus and yeasts—on the texture, flavor, and probiotic properties of surimi products. Various fermentation agents exert significant effects on surimi quality, and their efficacy is strongly influenced by fermentation conditions, including temperature and substrate ratio. Previous studies have demonstrated that inoculated fermentation not only enhances the flavor of surimi products but also promotes the development of health-related probiotic characteristics. Furthermore, this review highlights the roles of key enzymatic systems and their associated metabolic pathways in flavor formation, elucidating the mechanisms underlying flavor changes during fermentation and providing new insights into microbial interactions and their impacts on product characteristics throughout the fermentation process. By integrating current research findings, this review analyzes the major factors affecting the textural, sensory, and functional properties of fermented surimi products and summarizes the dynamic mechanisms of flavor evolution during fermentation, thereby providing a theoretical basis for the standardization and industrial application of inoculated fermented surimi products.