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The type of mesh (synthetic vs. biological) play integral roles in the recovery and long-term outcomes of patients undergoing hernia repair. The aim of this study was to determine whether a biological mesh from bovine pericardium is equivalent to a standard polypropylene mesh in an open inguinal hernia repair using the Lichtenstein technique.A prospective, randomized, double-blinded, single-center trial was conducted to evaluate the safety and efficacy of a biological mesh compared with a commonly used polypropylene mesh using Lichtenstein’s inguinal hernia repair in a 6-month study. Patients were evaluated for recurrence and complications by a blinded surgeon at 1 day, 1 week, 1 month, 3 months, and 6 months after surgery.A total of 132 patients were randomized into experimental group receiving the bovine mesh (n=66) and control group receiving the standard polypropylene mesh (n=66). No recurrences were diagnosed in both arms within 6-month follow-up. Patients in the experimental group reported markedly less groin pain during the 3-month postoperative assessment period compared with the control group. There were no statistically significant differences in other complications, such as incision inflammation, physical limitation, testicular problems, and foreign body sensation, between the 2 groups.Biological mesh is safe and effective in repairing inguinal hernia, with comparable intraoperative and early postoperative morbidity to the synthetic mesh.