Synthetic Mesh Has Lower Long-Term Recurrence than Biologic in Contaminated Ventral Hernia Repair

Remulla D, Carvalho A, Birrell AM, et al. Mesh-related Outcomes of Biologic Versus Synthetic Mesh for Single-stage Repair of Contaminated Ventral Hernias: A 5 to 10-year Analysis of a Randomized Controlled Trial. Ann Surg. March 2026.

This study is an extended follow-up of a multicenter RCT (253 patients) comparing biologic versus medium-weight polypropylene synthetic mesh in single-stage retromuscular repair of clean-contaminated and contaminated ventral hernias. 

Follow-up was achieved in 80% with a median of 5.4 years. Synthetic mesh demonstrated a lower cumulative midline recurrence risk (HR 0.46, 95% CI 0.25–0.86), with overall recurrence 23.6% for biologic versus 11.8% for synthetic, an absolute reduction of 11.8%. The recurrence advantage was largely realized in the first 2 postoperative years, with no statistically significant difference in new recurrences beyond 2 years among those recurrence-free at that landmark time point. 

The clinically important reassurance is that there were no new mesh infections or excisions beyond postoperative year 2 in either arm, and ongoing wound-related interventions after 2 years were uncommon. For contaminated and clean-contaminated fields, this supports synthetic mesh as the default when performing a single-stage retromuscular repair, given superior durability without a late infection in this cohort.