Abstract:Biologic meshes have been increasingly explored in hernia and abdominal wall surgery because of their potential advantages in promoting tissue regeneration and reducing permanent foreign-body implantation. However, their clinical efficacy has long lacked support from high-level evidence, and their role in inguinal and ventral hernia repair remains controversial. Recent randomized controlled trials and meta-analyses have shown that biologic meshes do not demonstrate clear superiority over synthetic meshes in terms of recurrence, postoperative complications, or cost-effectiveness. The BIOLAP randomized clinical trial published in 2025, which adopted a unique self-controlled design in patients with bilateral inguinal hernias, directly compared biologic and synthetic meshes in laparoscopic inguinal hernia repair. The study demonstrated that biologic meshes not only failed to reduce chronic postoperative pain, but were also associated with significantly higher rates of hernia recurrence and seroma formation, thereby challenging their routine clinical use. Based on the findings of the BIOLAP study, this article systematically reviews the material characteristics, clinical applications, and major controversies surrounding biologic meshes, with particular emphasis on current evidence in inguinal hernia repair, ventral hernia repair, and prophylactic abdominal wall reinforcement. In addition, the possible mechanisms underlying the limitations of biologic meshes and future directions for material innovation are discussed. Current evidence suggests that biologic meshes are unlikely to serve as a universal substitute for synthetic meshes, and their future value may lie in precision application in selected high-risk scenarios and in the development of novel intelligent, composite, and functional biomaterials.