TITLE:
Mesh Selection in Contaminated Ventral Hernia Repair—A Narrative Review of Comparative Evidence and Clinical Application
AUTHORS:
Junming Shi, Chuanchang Yin
KEYWORDS:
Ventral Hernia, Incisional Hernia, Contamination, Polypropylene Mesh, Biologic Mesh, Biosynthetic Mesh
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.11,
October
30,
2026
ABSTRACT: Background: In a contaminated ventral hernia, the choice of mesh must account for both recurrence and complications of the wound. Biologic implants gained acceptance partly because they were thought less vulnerable to infection. Comparative clinical studies have since called that assumption into question. Methods: We reviewed randomized comparisons and their later follow-up reports, comparative cohorts, prospective studies of biosynthetic mesh, and clinical guidelines. Targeted searches of PubMed-indexed records, Europe PMC, and publisher websites were last updated on September 9, 2026. We considered each result in relation to the wound class, operative setting, mesh position, fascial closure, and length of follow-up. This was a selective narrative review without a formal assessment of bias or statistical pooling. Findings: In the randomized trials, polypropylene reduced recurrence compared with the biologic meshes tested. The clearest evidence concerns planned reconstruction in clean-contaminated or contaminated wounds, completed in one operation. Later follow-up continued to favor polypropylene for recurrence, with no detected excess of late infection or mesh excision. The safety estimates remain imprecise, and these trials provide little guidance for dirty wounds, uncontrolled sepsis, or bridging an open fascial defect. Biosynthetic mesh cohorts report promising results after the implant has resorbed, but comparisons differ considerably in their patients and methods. Emergency guidelines also favor permanent macroporous mesh when implantation is appropriate; their advice on timing and mesh position reflects the constraints of emergency surgery. Conclusions: For elective contaminated reconstruction, the best comparative evidence supports macroporous polypropylene for repairs with fascial closure and retromuscular reinforcement. Biologic or biosynthetic mesh may be considered for a stated clinical reason, but contamination by itself has not been shown to confer an advantage on either material. Control of the infectious source and the feasibility of repair should guide the decision before a mesh is selected.