Efficacy and safety of ovine reinforced tissue matrix for ventral hernia repair: a systematic review and meta-analysis.

INTRODUCTION: OviTex® mesh is a reinforced tissue matrix (RTM) that combines biologic and synthetic components, aiming to reduce inflammatory response while providing durable abdominal wall support. Comparative analyses indicate it performs similarly to synthetic mesh regarding hernia recurrence and surgical site infection rates, and may be preferable in patients with increased risk factors or prior mesh infection. This systematic review and meta-analysis evaluated the efficacy and safety profile of OviTex, particularly in patients undergoing ventral hernia repair (VHR). METHODS: Following PRISMA guidelines, we searched PubMed, Embase, Scopus, and ClinicalTrials.gov from inception to September 2025. Studies comparing the use of OviTex in VHR with synthetic or other biologic meshes were included. The primary endpoint was recurrence rates. Secondary outcomes were surgical site occurrences (SSO) and hospital length of stay (LOS). Statistical analysis was performed with Review Manager 5.4 using a random-effects model. RESULTS: From 202 records, 9 met our inclusion criteria, to which 4 were included in our final pooled analysis. These studies encompassed 534 patients (OviTex n = 194 [36.3%]), with a mean follow-up time of 19.3 months, and a mean hernia defect size of 130.3 cm2. An open approach was specified in 171 (32%) cases. The overall primary fascial closure rate was 88%, with mesh most frequently placed in the retromuscular (39%) or intraperitoneal (35%) planes. Overall analysis showed significantly reduced recurrence rates (RR 0.45; 95% CI 0.22 to 0.94; p = 0.03) for patients using OviTex when compared with synthetic or other biologic meshes. There were no significant differences regarding SSO rates (RR 1.27; 95% CI 0.79 to 2.05; p = 0.32) and LOS (MD 3.18 days; 95% CI -6.38 to 12.74 days; p = 0.51) between groups. CONCLUSION: This systematic review and meta-analysis map the role of OviTex® for ventral hernia repair. Preliminary evidence indicates lower rates of recurrence at a mean follow-up of 19.3 months and comparable outcomes in terms of surgical site occurrences and length of stay. However, these findings are based on a limited number of observational studies, and further prospective research with longer follow-up is needed to confirm reinforced tissue matrices as a reliable alternative in patients at higher risk.