Research advances and challenges of the application of biomaterial mesh in ventral hernia repair

Ventral hernia represents a common disease in general surgery, with incisional and parastomal hernias as the most prevalent. Surgical principles have evolved from tension suturing to tension‑free repair using synthetic mesh in a bridging manner, significantly reducing postopera-tive recurrence rates. However, synthetic materials, being foreign bodies, may lead to complications such as chronic pain, mesh retraction, and mesh infection, with particular limitations in infected wounds. Biomaterial mesh offers a novel approach to addressing these challenges through their biocompatibility, degradability, and capacity to induce tissue regeneration. The authors systemati-cally review the classification and characteristics of biomaterial mesh, examine how differences in material origin and manufacturing processes influencing immunogenicity, degradation kinetics, and vascularisation potential. Building upon this foundation, this article explores clinical application advances of biomaterial mesh in clean wounds, infected wounds, and special patient subgroups. It analyses the conceptual shift from bridging to enhanced repair and the evidence‑based outcomes for key clinical endpoints. Consequently, it dissects core challenges, including uncontrolled long‑term recurrence rates, ambiguous boundaries of antimicrobial efficacy, healthcare economics dilemmas, and evidence confusion stemming from standardization gaps. Finally, future directions are outlined, encompassing gradient‑degrading materials, antimicrobial functionalization, patient stratification decision tools, and refined evidence‑based medical systems. It aims to provide guidance for the rational application and in‑depth research of biomaterial mesh in ventral hernia repair.