Functional outcomes of abdominal wall reconstruction with biological versus synthetic meshes in complex hernia repairs
DOI:
https://doi.org/10.33448/rsd-v15i2.50198Keywords:
Synthetic mesh, Biological mesh, Ventral hernia, Contaminated surgical field, Postoperative outcomes.Abstract
Introduction. The choice of mesh type for abdominal wall reconstruction in complex hernia repairs, especially in contaminated surgical fields, has been the subject of increasing debate in surgical practice. Objective. This study aimed to compare the clinical outcomes associated with the use of synthetic, biological, and biosynthetic meshes in complex hernia repairs, with emphasis on hernia recurrence, infectious complications, length of hospital stay, and hospital costs. Methodology. This is a narrative review of the literature, with selection of studies published between 2015 and 2025 in the PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases. Meta-analyses, systematic reviews, and comparative studies presenting quantitative data on the main clinical outcomes were included. Results and Discussion. Analysis of the nine selected studies indicated that synthetic meshes, even in contaminated environments, are associated with lower recurrence rates and significantly lower costs, without a proportional increase in infection rates. In contrast, biological meshes showed inferior outcomes in several studies. Biosynthetic meshes, such as RBOR, demonstrated promising performance, particularly in high-risk patients, although long-term studies are still lacking. Conclusion. Current evidence supports synthetic meshes as the first choice in complex hernia repairs, including contaminated fields. Biosynthetic meshes emerge as a promising intermediate alternative, and material selection should consider the patient’s clinical profile, associated costs, and institutional availability.
References
Atema, J. J. et al. (2016). Systematic review and meta-analysis of the repair of potentially contaminated and infected abdominal wall defects. American Journal of Surgery. 212(5), 982–95. Doi: 10.1016/j.amjsurg.2016.05.003.
Atema, J. J. et al. (2022). Biologic versus synthetic mesh in open ventral hernia repair: a systematic review and meta-analysis of randomized controlled trials. Surgery. 172(4), 1057–66. Doi: 10.1016/j.surg.2022.10.030.
Figueiredo, S. M. P. et al. (2023). Biologic versus synthetic mesh in open ventral hernia repair: a systematic review and meta-analysis of randomized controlled trials. Surgery. 173(3), 876–85. Doi: 10.1016/j.surg.2022.12.002.
Frountzas, N. et al. (2024). Outcomes of synthetic versus biologic mesh in abdominal wall reconstruction in contaminated fields: a meta-analysis. Hernia. 28, 1–11. Doi: 10.1007/s10029-024-02901-w.
Olavarria, O. et al. (2021). A pilot randomized controlled trial comparing synthetic and biologic mesh in ventral hernia repair. Surgical Infections. 22(5), 480–8. Doi: 10.1089/sur.2020.377.
Pereira, A. S., Shitsuka, D. M., Parreira, F. J. & Shitsuka, R. (2018). Metodologia da Pesquisa Científica. Santa Maria: Editora da UFSM
Rosen, M. J. et al. (2022). Biologic versus synthetic mesh for single-stage repair of contaminated ventral hernias: a randomized controlled trial. JAMA Surgery. 157(2), 149–157. Doi: 10.1001/jamasurg.2021.6035.
Rother, E. T. (2007). Revisão sistemática x revisão narrativa. Acta Paulista de Enfermagem. 20(2), 5-6.
Sivaraj, D. et al. (2022a) Outcomes of biosynthetic and synthetic mesh in ventral hernia repair. Plastic and Reconstructive Surgery – Global Open. 10(12), e4707. Doi: 10.1097/GOX.0000000000004707.
Sivaraj, D. et al. (2022b). Reinforced biologic mesh reduces postoperative complications compared to biologic mesh after ventral hernia repair. Plastic and Reconstructive Surgery – Global Open. 10(2), e4083. Doi: 10.1097/GOX.0000000000004083.
Timmer, A. S. et al. (2022). Clinical outcomes of open abdominal wall reconstruction with the use of a polypropylene reinforced tissue matrix: a multicenter retrospective study. Hernia. 26, 1481–90. DOI: 10.1007/s10029-022-02604-y.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Daniela Linhares Lima de Oliveira, Maria Fernanda Seixas Oliveira, Isabela Coqueiro da Silva, Samantha Habib Miguel Bomfim Ferreira, Thays Pessoa Tanajura, Rafaella Dantas de Carvalho, Camila de Britto Cunha Cockeis Guimarães, Joseane Oliveira Braga Nascimento, Rebeca Sampaio Feitosa, Anna Caroline Menezes Vasconcelos Negreiros, Lis Armede de Matos, Alice Oliveira de Almeida
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
