Comparative outcomes of biologic versus synthetic mesh in inguinal hernia repair: A systematic review and meta-analysis.

Abstract

The comparative effectiveness of biologic versus synthetic mesh in inguinal hernia repair remains uncertain, with existing studies reporting inconsistent findings. We aimed to report a meta-analysis of randomized controlled trials comparing the outcomes of synthetic and biologic mesh in open and laparoscopic inguinal hernia repair. A literature search of PubMed, Embase, Web of Science, and EBSCO databases was performed to identify randomized controlled trials comparing biologic and synthetic mesh in adult patients undergoing open or laparoscopic inguinal hernia repair. Postoperative outcomes were assessed using pooled analysis and meta-analysis. Risk ratios and standardized mean differences were calculated using random-effects models. Six randomized controlled trials involving 1,010 patients were included. There was no statistically significant difference in hernia recurrence between biologic and synthetic mesh (risk ratio, 2.45; 95% confidence interval, 0.90-6.66; P = .08). Biologic mesh was associated with a significantly higher risk of seroma formation (risk ratio, 1.58; 95% confidence interval, 1.07-2.34; P = .02), whereas no significant differences were observed in surgical site infection or hematoma. Postoperative chronic pain scores were significantly lower in the biologic mesh group (standardized mean difference, -0.37; 95% confidence interval, -0.63 to -0.11; P = .006), particularly following open repair. Biologic mesh did not demonstrate superiority over synthetic mesh in elective inguinal hernia repair, with no significant differences in recurrence or surgical site infection. Although biologic mesh was associated with reduced chronic postoperative pain, it was accompanied by a higher incidence of seroma and substantially increased cost. Further evaluation in large, multicenter, and well-designed randomized controlled trials with long-term follow-up is required.