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There are many studies comparing different mesh products and techniques. There is no best mesh. There is no ideal mesh. Whereas one patient may do very well with one type of mesh, another would not. For example, perhaps an obese patient will do better with a heavier weight mesh, a thin patient may do better with a lighter weight mesh or no mesh, a patient with a wide-based hernia may do better with a sandwich type designed mesh. A direct hernia may be best treated with a heavier weight mesh, but what if you are thin and have a direct hernia or a wide-based hernia? The permutations are plenty. There is no formula to plug in to tell you which patient will have the best outcome with which technique. Each surgeon has a different outcome with each technique and each patient has a different outcome with the same technique. That is where the art comes from.
Many mesh companies profit nicely from selling implants, especially since mesh repair is considered gold standard in the US. Surgeons don’t have contracts with mesh companies. In fact, in many situations, the type of mesh carried is an economic decision.
Medicine, as you may have figured out by now, is not a profits-first business. Patient needs supersede profit margins. Unlike most businesses, patients’ lives come first. So, e.g., if the patient requires a certain treatment, implant, procedure, etc., and they can’t pay for it, or their insurance doesn’t cover it, or the insurance pays too little to make the procedure profitable, that is often not a reason to prevent the patient from having a life-saving, life-altering, or to withhold health care. It is part of the reason why the US healthcare is bankrupt: improvements in technology and availability of new technology precludes the doctors to take advantage of the new technology and provide the best care to their patient, even though it is often at higher cost. Same with pharmaceuticals. The real winners are the industries that provide this technology. For sure, it is not the doctor. They intend to provide the best care for their patient.
Perhaps this is too much information.