Composite Meshes: A Comprehensive Review of Materials, Biomechanics, Clinical Outcomes, and Emerging Innovations

Hernia repair is among the most frequently performed surgical procedures worldwide. Composite meshes, that is, prostheses incorporating at least two distinct functional layers, were developed to reconcile the competing demands of structural durability and peritoneal biocompatibility. This narrative review synthesizes evidence from peer-reviewed research articles, physicomechanical evaluation studies, and clinical outcome data identified through PubMed, MEDLINE, and Scopus searches spanning 2000-2025. Composite meshes are broadly classified by barrier type as either absorbable or permanent (nonabsorbable). Key physicochemical parameters, namely, pore size, filament diameter, mesh weight, suture retention strength, tear resistance, and anisotropy, significantly influence host tissue integration and clinical performance. Absorbable barrier meshes, including C-QUR (Atrium Medical Corporation, Hudson, New Hampshire, United States), PROCEED (Ethicon, Inc. (a Johnson & Johnson company), Somerville, New Jersey, United States), Parietex Composite (Sofradim Production SAS (a Medtronic company), Trévoux, France), and Bard Sepramesh IP Composite (Davol Inc. (a subsidiary of C.R. Bard, Inc., now Becton, Dickinson and Company), Warwick, Rhode Island, United States), facilitate eventual tissue incorporation after barrier degradation within 30-120 days. Permanent barrier meshes, including DUALMESH (W.L. Gore & Associates, Inc., Flagstaff, Arizona, United States) and Bard Composix E/X and L/P (Davol Inc. (a subsidiary of C.R. Bard, Inc., now Becton, Dickinson and Company), Warwick, Rhode Island, United States), provide durable adhesion resistance through an intact expanded polytetrafluoroethylene surface. Clinically, composite meshes demonstrate recurrence rates comparable to conventional polypropylene with measurably reduced adhesion formation in the intraperitoneal position. Complications, including chronic pain, seroma formation, mesh shrinkage, infection, and rare visceral erosion, remain pertinent concerns. Future innovations, including drug-eluting coatings, auxetic mesh geometries, patient-specific three-dimensional printing, and biodegradable biosynthetic scaffolds, hold considerable promise in further optimizing surgical outcomes.