Research Appraisals

Hernia : the journal of hernias and abdominal wall surgery

Complications after biosynthetic long-term absorbable mesh implantation for ventral hernia repair in clean and contaminated environments: a systematic review and meta-analysis

BACKGROUND: Ventral hernia repair (VHR) remains a common yet complex surgical procedure, with substantial recurrence and complication rates. Long-term absorbable biosynthetic meshes have been introduced to provide temporary reinforcement while potentially reducing mesh‑related morbidity. OBJECTIVE: This meta-analysis evaluates the safety and effectiveness of long-term absorbable biosynthetic meshes in VHR by synthesizing both comparative and descriptive studies. METHODS: Databases were searched up to October 2025 for studies on VHR with long-term absorbable biosynthetic mesh. Descriptive studies were pooled using random-effects models to determine event rates. Comparative studies were analyzed using odds-ratios (ORs). RESULTS: Thirty-five descriptive single-arm studies and seventeen comparative studies were included. Descriptive hernia recurrence rate was 11.6% (95%CI 9.3-14.3%), surgical site infection (SSI) 11.8% (95%CI 9.2-15.0%), surgical site occurrence (SSO) 21.9% (95%CI 15.9-29.5%), seroma 9.7% (95%CI 7.2-12.9%), and SSO/SSI requiring surgical-intervention (SSOPI) 9.7% (95%CI 7.6-12.3%). Mesh infection and explantation rates were 0.3% (95%CI 0.0-1.0%) and 0.5% (95%CI 0.0-1.6%) both also in single-arm studies. A significantly lower hazard of recurrence 0.47 (95%CI 0.24-0.93), and a non-significantly lower risk of SSI, SSO, mesh explantation, and SSOPI compared to biologic meshes was found in comparative studies. Absorbable meshes showed a non-significant difference in recurrence rate versus permanent synthetic mesh (OR 0.93, 95%CI 0.57-1.52) but significantly lower odds of mesh explantation (OR 0.46, 95%CI 0.27-0.79). CONCLUSIONS: Long-term absorbable biosynthetic meshes show low mesh infection and explantation rates in the available literature. Comparative analyses suggest lower recurrence versus biologic meshes and fewer explantations versus permanent synthetic meshes; however, these findings are based on heterogeneous, predominantly retrospective data with limited follow-up and should not be considered conclusive.