Surgeons should weigh the trade-offs of biologic versus synthetic mesh in inguinal hernia repair, as this meta-analysis shows no significant advantage.

• No significant difference in hernia recurrence between biologic and synthetic mesh (risk ratio 2.45, p = .08).
• Biologic mesh led to higher seroma risk (risk ratio 1.58, p = .02) but lower chronic pain scores (standardized mean difference -0.37, p = .006).

Consider costs and seroma risks when selecting mesh type for patients.

• No differences noted in surgical site infections or hematomas.