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

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Literature Selections

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

Selection prepared by Christopher DuCoin, MD, MPH, FACS

March 10, 2026

Remulla D, Carvalho A, Birrell AM, et al. 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鈥�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.

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

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