Comparative outcomes of synthetic and biological mesh use in laparoscopic inguinal hernia repair: a systematic review and meta-analysis.

Abstract

Background: Inguinal hernias occur when abdominal contents protrude through the inguinal canal. Laparoscopic repair is often preferred due to reduced postoperative pain, quicker recovery, and better cosmetic results. While synthetic mesh remains the standard, concerns about complications have prompted interest in biological meshes, which may integrate better with tissue but are more expensive and lack long-term data.

Methods: We conducted a meta-analysis of studies published between 2015 and 2025 that compared biological versus synthetic mesh in laparoscopic inguinal hernia repair among adults. Only randomized controlled trials and cohort studies published in English were included. The primary and secondary outcomes were hernia recurrence and postoperative complications.

Results: Out of 6017 records, three studies involving 1372 participants met the inclusion criteria. All compared porcine small intestinal submucosa (SIS) biological mesh with synthetic mesh. SIS mesh was associated with longer operating times (SMD 0.45; 95% CI: 0.02-0.87; p = 0.039). However, there were not a statistically significant differences in recurrence (RR 12.73; p = 0.15), complications (RR 3.06; p = 0.55), or adverse events (RR 5.38; p = 0.21). Heterogeneity was high, and funnel plots suggested possible publication bias.

Conclusion: Biological mesh did not show a clear benefit over synthetic mesh in laparoscopic inguinal hernia repair. While it may reduce chronic pain, it requires longer operative time and raises concerns about cost and long-term outcomes. Larger, high-quality studies are needed to clarify their role in clinical practice.