The performance of synthetic meshes available for the repair of abdominal wall hernias is determined by factors related to the polymer used to make the mesh, to the structural conformation of the mesh, which is influenced by the type of polymer fiber composing it, textile characteristics and porosity of the mesh, prosthesis and the interaction between the mesh and the tissue9. However, this mechanistic view that the biomechanical properties of the meshes would guarantee the success of hernioplasty is being rethought. The biological response to the presence of the mesh had a key role in the outcome of the treatment performed here. The understanding that the mesh determines structural changes in the tissues with which it comes into contact, as well as the counterpart of the impact of the biological process of incorporation of the mesh, marked by the balance of inflammation response and fibroplasia, decisively influence the result of the repair with synthetic meshes of abdominal wall defects. It refers to the need to create a mesh-tissue integration index as a new reference for evaluating the performance of a synthetic mesh28.