Efficacy of biological versus synthetic meshes in laparoscopic inguinal hernia repair: a systematic review and meta-analysis of randomized controlled trials

In laparoscopic inguinal hernia repair, synthetic meshes are widely used but carry risks such as chronic pain and a foreign body sensation. Biological meshes, as emerging materials, have not yet reached a consensus regarding their clinical effectiveness compared to synthetic meshes. A systematic search of English and Chinese databases was conducted for randomized controlled trials (RCTs) up to January 25, 2026, comparing the clinical outcomes of biological and synthetic meshes in laparoscopic inguinal hernia repair. Meta-analysis was performed using RevMan 5.4 software. The Cochrane Risk of Bias Assessment Tool and the GRADE system were employed to evaluate the study quality. A total of 5 RCTs, involving 1,222 patients, were included. The meta-analysis showed that the biological mesh group had significantly higher pain scores on postoperative day 1 compared to the synthetic mesh group (MD = 0.59, 95% CI: 0.30–0.88, P < 0.0001), and on postoperative day 2 (MD = 0.35, 95% CI: 0.04–0.67, P = 0.03). The incidence of seroma was significantly higher in the biological mesh group than in the synthetic mesh group (RR = 1.56, 95% CI: 1.27–1.91, P < 0.0001). No statistically significant differences were found between the two groups in terms of foreign body sensation (RR = 0.64, 95% CI: 0.11–3.73, P = 0.62) and recurrence rate (RR = 1.96, 95% CI: 0.19–20.61, P = 0.57). GRADE evaluation showed that the evidence quality was moderate for postoperative pain scores on day 1 and seroma incidence, low for postoperative pain scores on day 2, and very low for both the incidence of foreign body sensation and recurrence rate. In laparoscopic inguinal hernia repair, biological meshes were associated with higher postoperative pain scores and seroma incidence compared to synthetic meshes, with no significant difference in foreign body sensation. For recurrence rate, the pooled analysis was not significant; however, the largest trial favored synthetic mesh, and this outcome should be interpreted with caution.