I.- FLAT MESHES FOR INGUINAL AND VENTRAL HERNIA REPAIR

I.- FLAT MESHES FOR INGUINAL AND VENTRAL HERNIA REPAIR Optilene Mesh B Braun Universal- light mesh for inguinal and incisional hernia repair Optilene Mesh is an universal mesh, which combines a lightweight concept with an excellent handling. It is a soft, large pore elastic mesh which is both strong and has excellent spread characteristics. When Optilene Mesh is chosen, there is no need to modify the surgical technique. The blue guidelines allow for a well directed placement. It provides optimal handling for open and laparoscopic applications. Optilene Mesh is a universal mesh suitable for all hernias as it can be used for both inguinal and incisional hernia repairs Fast tissue integration Universal light- weight & large pores Blue guidelines with reinforced monofilament Soft, convenient and strong Fully transparent Elastic High biocompatibility Open and laparoscopic procedures http://www.bbraun.com/cps/rde/xchg/bbraun- com/hs.xsl/8886.html

Optilene Mesh LP B Braun Super- light and thin- walled mesh with full transparency Low- weight (36g/m2) and large pore (1mm ) Optilene Mesh LP is a super- light monofilament polypropylene mesh which offers an excellent biocompatibility. The foreign body reaction is reduced considerably. Optilene Mesh LP is the alternative super- light mesh for all open hernia repair procedures. It perfectly conforms to anatomical structures. Due to its excellent flexibility Optilene Mesh LP adapts to the patient s anatomy and movements resulting in a higher comfort. Optilene Mesh LP offers extreme dimensional stability as well as full transparency so that the tissue underneath is visible during surgery. Super- light polypropylene Fast tissue integration Soft, thin and pliable Comfortable Full transparency Flexible, strong and secure Ideal for inguinal hernia repair to reduce chronic pain http://www.bbraun.es/cps/rde/xchg/cw- bbraun- es- es/hs.xsl/products.html?id=00020742190000000555&prid=prid 00003022

Optilene Mesh Elastic B Braun Elastic lightweight and large pore mesh Low- weight (48g/m2) and large pore (3,6x2,8mm ) Optilene Mesh Elastic is a light- weight large pore monofilament polypropylene mesh. Due to the exact elasticity of the abdominal wall it is able to adapt to all movements taking place. The new honeycomb like structure, with one of the largest pores available on the market, permits an ideal healing and the formation of an elastic scar. Optilene Mesh Elastic is ideal for incisional hernia repair and can also be used to repair inguinal hernias. Optilene Mesh Elastic helps to maintain an excellent abdominal wall physiology resulting in a greater convenience and comfort for the patient Mimics the abdominal wall elasticity Light- weight mesh Large pores Excellent patient comfort Better tissue integration Ideal for incisional hernias Suitable to prevent incisional hernias http://www.bbraun.com/cps/rde/xchg/bbraun- com/hs.xsl/8902.html

Premilene Mesh B Braun Polypropylene mesh for hernia repair Premilene Mesh, made from monofilament polypropylene, is used for hernia repair or for reconstruction of the chest wall. The monofilaments are knitted into an elastic, durable, mesh. Premilene Mesh is characterized by the extreme dimensional stability of its thin mesh wall. It adapts optimally to movements of the patient. The technically advanced mesh structure is retained after cutting and does not fray. Premilene Mesh is highly transparent so that tissue underneath is visible during surgery. Rapid healing and tissue penetration Thin mesh structure Excellent transparency Good handling Excellent biocompatibility http://www.bbraun.es/cps/rde/xchg/cw- bbraun- es- es/hs.xsl/products.html?id=00020742190000000555&prid=prid 00000807

BARD Mesh Bard, Davol BARD Mesh was used by Dr. Irving Lichtenstein when he first developed the first "tension- free" hernia repair technique many years ago. More than 45 years of clinical experience. Can be tailored perioperatively and customized to any unique situation. Available in seven convenient sizes. Precut BARD Mesh offers unparalleled convenience, while reducing overall waste and operating time. Because the shapes are precut, the need to trim the mesh perioperatively is minimized. An optional precut opening fits around the spermatic cord, and the rounded edges accommodate to the anatomy of the inguinal canal. Well tolerated by the body. Made of widely spaced monofilament fibers which cannot harbor bacteria. http://www.davol.com/products/soft- tissue- reconstruction/hernia- repair/inguinal- hernia- repair/bard- mesh/

BARD Soft Mesh Bard, Davol Large pore monofilament polypropylene mesh that has a soft, compliant knit structure. Approximately 60% lighter- weight than traditional polypropylene mesh. Thin, low profile facilitates mesh positioning. Soft compliant knit structure is easily tailored without unraveling. Available as flat or pre- shaped mesh. http://www.davol.com/products/soft- tissue- reconstruction/hernia- repair/inguinal- hernia- repair/bard- soft- mesh/

VISILEX Mesh Bard, Davol Specifically designed for laparoscopic inguinal hernia repair Reinforced edge facilitates deployment and placement. Retains shape after introduction through a trocar. Trusted and proven material. http://www.davol.com/products/soft- tissue- reconstruction/hernia- repair/inguinal- hernia- repair/visilex- mesh/

PARIETEX PRO- GRIP SELF FIXATING MESH Covidien Self- gripping, semi resorbable lightweight mesh available for inguinal and incisional hernia repair. In hernia repair, surgeons want to balance security and patient comfort with ease of use. Parietex ProGrip self- fixating mesh delivers all three. Its advanced microgrip technology provides immediate fixation1 of the entire mesh surface for a secure repair and even distribution of tension for patient comfort. Designed for ease of use, the resorbable polylactic acid (PLA) microgrips enable surgeons to position and place the mesh in under 60 seconds2, without the use of additional fixation1. Surgeons and patients can depend on a secure repair with the potential for greater patient comfort. All of Covidien s Parietex products are created from a macroporous polyester material which produce superior cellular proliferation when compared to polypropylene mesh in vitro. Immediate fixation of the entire mesh surface as opposed to individual suture points on the peripheral edge Substantially stronger incorporation than fibrin glue and equivalent incorporation to hernia stapler fixation at five days Even distribution of tension across the repair rather than focusing tension on individual fixation points Reduces potential of chronic groin pain from sutures entrapping nerves Position and place in less than 60 seconds Easy and secure positioning of mesh around the cord http://www.covidien.com/hernia/mesh/selffixating

PARIETEX Lightweight Monofilament MESH Covidien Parietex lightweight monofilament mesh is designed to provide patients the optimal clinical benefits of polyester in a strong, lightweight, monofilament knit for lasting comfort. All of Covidien's Parietex products are created from a macroporous polyester material whose properties invite healthy tissue integration and mesh compliance while reducing encapsulation. Produces superior cellular proliferation when compared to polypropylene mesh in vitro Designed with optimal surface porosity for better tissue ingrowth Balanced with a high level of tensile tear strength and suturing strength for durability http://www.covidien.com/hernia/mesh/monofilamentmesh PARIETEX Flat Sheet MESH Covidien Parietex Flat sheet mesh comes in both 2D weaves (TEC) and 3D weaves (TET) designs. The 2D weave is a lightweight, macroporous mesh with a design that is rigid, making it ideal for laparoscopic applications due to its handling properties.

The 3D weave is also a lightweight, macroporous mesh but has a design that provides softness. This 3D weave allows for compliance and isometric movement with the patient. Its macroporous nature provides optimal cell ingrowth. All of Covidien's Parietex products are created from a macroporous polyester material whose properties invite healthy tissue integration and mesh compliance while reducing encapsulation. Enhance tissue integration and mesh compliance while reducing encapsulation. Designed with patient comfort in mind. http://www.covidien.com/hernia/mesh/flatsheet Surgipro Flat Sheet Mesh Covidien Surgipro Flat Sheet mesh is a nonabsorbable, polypropylene surgical mesh exhibiting high burst strength and tensile strength. Surgipro comes in multiple designs, including multi- filament, monofilament and open weave. All designs are knitted in such a fashion as to provide bi- directional elasticity, while allowing the mesh to be cut to any shape without unraveling. Strength. Excellent visibility. Ease of handling and position. Retains properties in- vivo Strength. Excellent visibility. Ease of handling and position.

http://www.covidien.com/hernia/mesh/surgiproflatsheeth MERSILENE Polyester Fiber Mesh Ethicon MERSILENE Polyester Fiber Mesh is designed for consistent deployment. This nonabsorbable mesh is used for the repair of hernia and other fascial defects that require a reinforcing material for extended support during and following healing. http://www.ethicon.com/healthcare- professionals/products/hernia- solutions/mersilene- polyester- fiber- mesh PROLENE Polypropylene Mesh Ethicon PROLENE Polypropylene Mesh is a nonabsorbable mesh indicated for the repair of abdominal wall hernias and other fascial defects.

http://www.ethicon.com/healthcare- professionals/products/hernia- solutions/prolene- polypropylene- mesh PROLENE Soft Polypropylene Mesh Ethicon Ethicon offers PROLENE Soft Polypropylene Mesh for the repair of abdominal wall fascial defects. A nonabsorbable synthetic surgical mesh that is designed for greater patient comfort and healing. http://www.ethicon.com/healthcare- professionals/products/hernia- solutions/prolene- soft- polypropylene- mesh ULTRAPRO Partially Absorbable Lightweight Mesh

Ethicon ULTRAPRO Partially Absorbable Lightweight Mesh is a unique and superior macroporous partially absorbable mesh. Designed for open and laparoscopic hernia repairs, it allows surgeons the versatility to perform various hernia repairs with a single technology. It offers excellent strength with minimal foreign body mass, to allow patients to heal more naturally with increased comfort and mobility. Allow Patients to Heal More Naturally http://www.ethicon.com/healthcare- professionals/products/hernia- solutions/ultrapro- partially- absorbable- lightweight- mesh PROLITE Mesh Atrium As published studies have shown, not all polypropylene mesh or highly porous mesh products perform the same. It is also clear that not all meshes feel the same, handle the same and most important, do not deliver the same clinical outcome. Only one has been carefully engineered to deliver the now proven performance results, preferred by most surgeons and patients alike. Less pain, enhanced patient comfort, fewer recurrences or complications are all desirable characteristics that cannot be achieved with just any prosthetic mesh implant.

Atrium utilizes a unique knit construction whereby its monofilaments are aligned in parallell spaced angles, to maximize material flexibility in two dimensions. No bulky "rails" of compacted or flattened filaments, just a smooth and very uniform open architecture. Next we developed a proprietary material process to help "relax and stabilize" the mesh polymer so it responds to flexing and handling without classic "window shade" memory, commonly found with more traditional, less flexible polypropylene constructions. Surgical mesh and plug innovations evolved from experts in biomaterial science. http://www.atriummed.com/en/biosurgery/prolite.asp PROLITE Ultra Mesh Atrium Atrium's ProLite Ultra Mesh is the next generation of thin wall polypropylene mesh for laparoscopic and traditional hernia surgery and general soft tissue repair. Its unique Litemesh polypropylene microfilament construction issofter and more supple than traditional mesh products and slightly thinnerthan Atrium s ProLite mesh. For those surgeons who demand a thinner, better handling and more flexible polyproplylene mesh, you need to look no further than ProLite Ultra. http://www.atriummed.com/en/biosurgery/prolite- ultra.asp

C- QUR FX Mesh Atrium Designed for open and laparoscopic hernia repair when a tissue separating layer is not needed, C- QUR FX filament coated mesh is the open pore ProLite family of polypropylene mesh with an absorbable, 30- day, all- natural pharmaceutical gradeomega 3 fatty acid (O3FA) coating. The open pores and filament coating help promote rapid, more complete incorporation throughout. The O3FA filament coating incites a less severe inflammatory response when compared to bare polymer meshes allowing for less fibrous formation and less rigid tissue incorporation. Atrium has carefully researched and tested C- QUR FX to ensure the optimization of necessary mechanical features for a strong, long lasting repair. By all measures, C- QUR FX Mesh outperforms all bare polymer products in terms of ease- of- use. The smooth O3FA coating provides uncompromised memory with significantly improved handling. The O3FA filament coating also enhances tight trocar roll up capability with minimal to no edge curl following laparoscopic deployment. C- QUR FX Mesh lays flat and glides along tissue for unmatched surgical convenience and ideal anatomical conformance. http://www.atriummed.com/en/biosurgery/cqur- fx.asp

DynaMesh- LICHTENSTEIN Dynamesh Material: 100% PVDF (Polyvinylidene Fluoride) monofilament Effective porosity: 65.5 % 1) Reactive surface: 1.38 m²/m² 31 N Excellent Material: 100% PVDF Anatomic Correct Design Atraumatic Selvedges Optimal Handling http://en.dyna- mesh.com/aplprod/hernia/lichtenstein- gb/

DynaMesh- CICAT Dynamesh Material: Polyvinylidenefluoride (PVDF) Monofilament Pore size: 3 x 3 / 3 x 2 mm Effective porosity: 60 % Maximum stability: > 32 N/cm Maximum tear propagation resistance: > 26 N Excellent Material: 100% PVDF High tear propagation resistance Tri- Elasticity adapted to the biomechanical characteristics of the abdominal wall Unique application Excellent porosity for fast incorporation Antislip surface http://en.dyna- mesh.com/aplprod/hernia/cicat- gb/ DynaMesh- CICAT Dynamesh Material: 100% PVDF (Polyvinylidene Fluoride) monofilament Effective porosity: 63.4 % Reactive surface: 1.35 m2/m2 Suture pull out strength: 31 N Tear propagation resistance: 21 N Fixation: all common fixation methods

Especially engineered for endoscopic and laparoscopic repair of inguinal hernias Excellent Material: 100 % PVDF Perfect Mesh Structure Atraumatic Selvedges http://en.dyna- mesh.com/aplprod/hernia/endolap- gb/ DynaMesh- PP Standard Dynamesh DynaMesh- PP mesh implants, light and standard version, can be used for all common open and laparoscopic techniques of inguinal or incisional hernia repair Material:100% Polypropylene (PP) monofilament Weight: 72 g/m² Thickness: 0.7 mm Pore size: 1.4 mm x 1.8 mm Effective porosity: 21 % Reactive surface: 1.91 m²/m² Max. stability: 59 N/cm Physiol. elasticity at 32 N/cm: 25 % Max. suture pull out strength: 43 N Excellent bio- compatibility Very good ageing resistance Excellent memory effect Optimal dynamometrical properties http://en.dyna- mesh.com/aplprod/hernia/pp- gb/

DynaMesh- PP Light Dynamesh DynaMesh- PP mesh implants, light and standard version, can be used for all common open and laparoscopic techniques of inguinal or incisional hernia repair Material:100% Polypropylene (PP) monofilament Weight: 36 g/m² Thickness: 0.6 mm Pore size: 1.6 mm x 2.6mm Effective porosity: 42 % Reactive surface: 1.11 m²/m² Max. stability: 38 N/cm Physiol. elasticity at 32 N/cm: 34 % Max. suture pull out strength: 30 N Excellent bio- compatibility Very good ageing resistance Excellent memory effect Optimal dynamometrical properties http://en.dyna- mesh.com/aplprod/hernia/pp- gb/

Basic- M Dipromed Medium weight and low density polypropylene, non- absorbable mesh lndications:treatment of the abdominal wall defects in open or laparoscopie surgery http://www.dipromed.eu/?page_id=267 Bulev Dipromed Macroporous lightweight mesh in polypropylene monofilament Easy handling, new balance between weight and stability http://www.dipromed.eu/?page_id=273

P3- Basic Dipromed Treatment of inguinal hernias in open surgery http://www.dipromed.eu/?page_id=277 P3- Evolution Dipromed Macroporous lightweight mesh in polypropylene monofilament Easy handling, new balance between weight and stability http://www.dipromed.eu/?page_id=279

FlaPp ClearMesh Composite Dipromed 2P- FlaPp CMC is a transparent, lightweight, ultra- thin, nonabsorbable surgical prosthesis in polypropylene, made by a monofilament macroporous mesh and a transparent film in order to minimize the adhesion formations. 2P- FlaPp CMC is a cutting prosthesis, according to instruction for use. Indications: Treatment of large abdominal wall defects with peritoneal- fascial loss of substance, according to modified Rives technique. http://www.dipromed.eu/?page_id=304 Biomesh A2 Cousin Polyethylene terephthalate and dimethyl siloxane knit Universal mesh The robustness and biological tolerance provide a guarantee of security. Hydrophilic material: better integration High mechanical resistance Flexibility

Easy to secure Blocked mesh http://www.cousin- biotech.com/uk/produit.php?idrubrique=7&idspecialite=17 &idcategorie1=51&idcategorie2=51&idproduit=104 Biomesh P1 Cousin 100% knitted polypropylene monofilament. The basic mesh for hernia repair The easy- to- cut mesh can be adapted to suit the surgical technique and the patient's anatomy. 'Gold standard': 100 g/m2 Flexibility Macroporous Transparent mesh http://www.cousin- biotech.com/uk/produit.php?idrubrique=7&idspecialite=17 &idcategorie1=51&idcategorie2=51&idproduit=105

Biomesh P8 Cousin Lightweight polypropylene mesh Its properties, elasticity, resistance and weight all meet the criteria for an ideal implant in the treatment of ventral hernia. The high porosity of the mesh ensures the best possible integration in the abdomen Respects abdominal movement Reduces inflammatory reactions Limited shrinkage Appropriate mechanical resistance (>32N/cm) Flexibility Transparent mesh 100% knitted polypropylene monofilament. Lightweight knit < 40 g/m2 http://www.cousin- biotech.com/uk/produit.php?idrubrique=7&idspecialite=17 &idcategorie1=51&idcategorie2=51&idproduit=103

NAME of the products Premium Cousin Lightweight polypropylene mesh Advantages of lightweight implants Reduced inflammatory reaction compared to heavyweight Good elasticity Less post- operative pain Limited skrinkage Suitable mechanical strength Macroporous: good tissue integration http://www.cousin- biotech.com/uk/produit.php?idrubrique=7&idspecialite=17 &idcategorie1=51&idcategorie2=51&idproduit=138 NAME of the products Biomesh P9 Cousin Lightweight polypropylene mesh With a lightweight resitance, BIOMESH P9 is ideal for laparoscopic use. 100% knitted polypropylene monofilament.

Lightweight knit < 40 g/m2 Soft material Macroporous Limited shrinkage Shape memory and transparency for easy implantation http://www.cousin- biotech.com/uk/produit.php?idrubrique=7&idspecialite=19 &idcategorie1=47&idcategorie2=47&idproduit=100 Biomesh A2 Cousin Wall reinforcement mesh Thanks to their hydrophilic material, Biomesh A2 panels offer optimal integration. Easy to cut Polyethylene terephthalate and dimethyl siloxane knit Transparent Macroporous mesh Out- patient surgery http://www.cousin- biotech.com/uk/produit.php?idrubrique=7&idspecialite=19 &idcategorie1=49&idcategorie2=49&idproduit=75

NAME of the products Premium Cousin Lightweight polypropylene mesh Advantages of lightweight implants Reduced inflammatory reaction compared to heavyweight Good elasticity Less post- operative pain Limited skrinkage Macroporous: good tissue integration http://www.cousin- biotech.com/uk/produit.php?idrubrique=7&idspecialite=19 &idcategorie1=49&idcategorie2=49&idproduit=137 NAME of the products Preshaped Hertra mesh Herniamesh Rigid and semirigid preshaped meshes: Hertra 1, 2 and 2A Rigid and semirigid preshaped Hertra 1, 2 and 2A meshes are used to repair inguinal hernias in open surgery, and are easily and rapidly positioned as a result of their rigidity and shape- memory features. For this reason, Hertra 1, 2 and 2A

meshes do not require sutures or other fixing methods, and are the only original means of repairing inguinal hernias by the sutureless Trabucco tension- free method. Hertra 1 and 2 meshes are indicated for male inguinal hernia repairs: the eccentric eye is in an anatomically correct position for the passage of the spermatic cord, and the prosthesis design is the result of hundreds of inguinal canal measurements performed by Prof. Trabucco. The Hertra 2A mesh is used for female or male inguinal hernias in orchifunicolectomy cases. http://www.herniamesh.com/en/ Preshaped T5 meshes Herniamesh Rigid or semi- rigid preshaped meshes with eccentric eye, used in male inguinal hernia defects in the presence of significant destruction or weakness of the posterior wall. This mesh is used with the preshaped Hertra. The T5 mesh is positioned below the transversalis fascia and the distance between the T5 and the Hertra prosthesis can be adapted in the most appropriate anatomic manner via the feedthrough suture system created by Prof. Trabucco. http://www.herniamesh.com/en/

Flat Oval mesh Herniamesh Rigid, flat oval meshes, indicated for preperitoneal repair of abdominal and incisional hernias. These meshes can be implanted by the Trabucco "Tension- free, sutureless" technique, availing of following advantages: - less risk of nerve entrapment; - less risk to muscles damage; - less postoperative pain; - no limitation to physical activities. http://www.herniamesh.com/en/ Flat rectangular and square mesh Herniamesh Flat meshes allow the surgeon to customise the prosthesis, cutting and shaping it to suit the size of the hernia and the area to be reinforced, so providing maximum versatility and flexibility. The various types of mesh available are the result of combination of different wefts, thicknesses and grammage; they are all macroporous, and can be used to treat both inguinal and abdominal hernias (umbilical, epigastric, lumbar and ventral hernias), allowing a wide choice of mesh and surgical technique.

As a result of its rigidity and shape- memory features, Hertra 0 mesh is ideal for open surgery using the "Tension- free, sutureless" Trabucco technique in obese patients and in large eventrations; Hermesh 3, Hermesh 4 and Hermesh 5 meshes adapt very well to any surgical technique and can be used in laparotomy and laparoscopic surgery; Hermesh 6 is a light mesh; Hermesh 7 is an ultra- light mesh; Hermesh 8 is a quadriaxial woven light mesh1. Its 16x40 cm size is especially recommended for preventing incisional hernias in high- risk patients when undergoing laparotomy for liver or kidney transplant. http://www.herniamesh.com/en/