The use of biological mesh for single-stage repair of hernias in contaminated or clean-contaminated fields has been driven by surgical dogma and fueled by a paucity of high-level evidence. There is a persistent fear that synthetic mesh in nonclean fields will result in mesh infection, spiraling into disastrous outcomes. The practice of using considerably more expensive biological mesh in contaminated or clean-contaminated fields is thought to be the best option despite an abundance of retrospective studies demonstrating high recurrence rates.¹ This practice continues while the alternative, synthetic mesh, has shown favorable performance in retrospective cohorts in contaminated fields² and, more recently, in a randomized clinical trial in clean-contaminated fields.³ As a consequence, biological mesh for single-stage repairs remains common practice, associated with significantly higher costs with inferior outcomes.^1,4