Using synthetic mesh in contaminated ventral hernia repairs shows better long-term outcomes than biologic mesh, crucial for surgical decision-making.

• Midline hernia recurrence rate was 11.8% with synthetic mesh vs. 23.6% with biologic, translating to an 11.8% absolute risk reduction.
• No new mesh infections or excisions reported beyond 2 years; only 1.2% needed intervention for wound issues.

Focus on synthetic mesh to improve long-term patient outcomes without increasing complications.