Next-generation mesh materials, beyond polypropylene and biologics: A scoping review

Hernia repair remains one of the most frequent surgical procedures worldwide, with more than 20 million cases performed annually. Although polypropylene has served as the clinical workhorse since the mid-20 th century due to its mechanical strength and accessibility, it is often limited by complications such as infection, fibrosis, and chronic pain. This scoping review synthesizes the evolution of mesh technology, evaluating the transition from traditional synthetics and biologics toward next-generation biomaterials. While biologic and biosynthetic meshes were developed to offer improved biocompatibility, they are frequently hindered by high recurrence rates, prohibitive costs, and uncertain long-term durability under physiological stress. Emerging innovations-including composite designs, antimicrobial coatings (such as benzalkonium chloride), and nanotechnology-enhanced nanofiber scaffolds-aim to bridge these gaps by fostering regenerative healing rather than mere structural reinforcement. Furthermore, the integration of 3D printing and artificial intelligence (AI) heralds a new era of personalized medicine, allowing for bespoke mesh design, predictive outcome modeling, and intraoperative guidance. Ultimately, hernia mesh innovation is shifting from passive, inert barriers toward intelligent, adaptive scaffolds that harmonize with human biology. While regulatory and manufacturing hurdles remain, these advancements signal a transformative shift in the future of abdominal wall reconstruction.