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9%, 13.5%, 17.3%, and 18.8% at 1, 3, 5, and 7 years, respectively. There were no differences in HR(p = 0.83) and SSO(p = 0.87) between the two mesh types. SSOs were identified in 27% of patients. In our LTF group (n = 162), the HR rate was 16%. Obesity, bridged repair, and concurrent stoma presence/creation were independent predictors of HR; component separation was protective against HR. Despite its use in complex AWR, ADM provides durable long-term outcomes with relatively low recurrence rates. Despite its use in complex AWR, ADM prov