Vol. 9, Issue 4, Part A (2025)

Over the last two decades, biological meshes have emerged as a promising tool in hernia repair, especially in contaminated or complex abdominal wall defects. These biologic scaffoldsderived from human, porcine or bovine tissues are marketed as offering improved host integration and lower infection risk compared to synthetic meshes. This narrative review examines current evidence on indications for biological mesh use, clinical outcomes (including recurrence, infection, and mesh failure), and cost-effectiveness compared to synthetic and biosynthetic alternatives. We highlight that while biologic meshes hold intuitive appeal in challenging surgical fields, the evidence base remains uneven: randomized trials are scarce, outcome heterogeneity is high and cost remains a major barrier. On balance, for standard clean hernia repairs, synthetic meshes continue to be more cost-effective and durable; biologic meshes may have a role in carefully selected contaminated or high-risk contexts. Future directions include refining patient selection, head-to-head trials, and economic modelling to optimise value in hernia surgery.