Biosynthetic vs. Synthetic Mesh in Retrorectus Ventral Hernia Repair: A Matched Analysis with Three-Year Outcomes

Background

Ventral hernias are a common surgical issue, with over 600,000 repairs performed annually in the U.S. Surgical repair with mesh reinforcement significantly reduces recurrence rates compared to suture repair alone. Synthetic meshes provide strong reinforcement but are associated with complications such as infection, chronic pain, and adhesions. In contrast, biologic meshes were developed to reduce foreign body response, but they are significantly more expensive and may have higher recurrence rates. Biosynthetic meshes aim to combine the strength of synthetic materials with the biocompatibility of biologics. These include fully resorbable polymers like poly-4-hydroxybutyrate (P4HB), offering potential benefits in tissue integration and infection resistance. However, comparative data between biosynthetic and synthetic meshes remain limited, especially regarding long-term outcomes such as recurrence and complications. The evidence is often conflicting, with heterogeneity in study designs, indications, and follow-up durations. This study compares long-term outcomes of retrorectus ventral hernia repair (VHR) using uncoated polypropylene synthetic mesh vs. P4HB biosynthetic mesh in clean wounds, focusing on:Hernia recurrence, Surgical site occurrences (SSOs), Reoperation/Readmission/ED visit rates