Hernia Treatment To the Future Together Hernia Repair

Hernia Treatment
To the Future Together
Hernia Repair
2
Hernia Repair is the most frequent procedure in general
surgery of the abdominal area. The treatment of hernias is
therefore for every surgeon and hospital of utmost medical
and economical importance.
Through the history of hernia treatment there have been many new techniques and innovations, but there is still
space for further developments and improvements. It is a must
to develop always better materials to improve the convenience
of the patient and to further lower the recurrence rates. Many studies show that the use of new mesh implants can reduce the rate of recurrency in hernia treatment.
The future lies in the well-tested and established hernia
methods with the new implants and materials.
The usable sutures and implants in hernia surgery has to meet
special quality requirements. To keep this quality it’s necessary to have commitment in a new research and development.
B. Braun plays a leading role in innovations due to the
research and development in all fields of medical surgery.
Innovation is the only way to the future and that’s why
the contact with the surgeons is really important to us.
Only with the help of them we can act to the new needs.
Our secret of success is a philosophy of Sharing Expertise.
B. Braun offers a dialogue to go to the future together!
3
Inguinal Hernia
Description:
Treatment:
A hernia occurs when the inside layers of the abdominal wall
weaken then bulge or tear. The inner lining of the abdomen
pushes through the weakened area to form a sac.
Nowadays the treatment method for the inguinal hernia
is a small operation, which is one of the most common
operations performed by surgeons.
There are several types of hernia, but the most
important are:
Umbilical hernias
Open repair
– Without mesh: Bassini, Shouldice
– Tension free method with mesh: Lichtenstein
Incisional hernias
Endoscopic repair with meshes
Femoral hernias
TAPP, TEP
Inguinal hernias
The most common hernia type is the inguinal hernia,
which has two types:
Indirect - a protrusion through the internal inguinal
ring passes along the inguinal canal through the
abdominal wall. This is the more common form
accounting for 80 %.
Direct - hernia protrudes directly through the
abdominal wall into inguinal canal.
4
There are two kinds of operation of the inguinal hernias:
Experience shows that the use of the mesh reduces the
recurrence rate. According to the new researches the
ideal pore size guarantees, that the mesh won’t cause
discomfort for the patients. All of Aesculap products fit to
these new needs.
Our main aim is to give a short description about these
techniques, and what kind of tools, sutures and implants
are recommended for the techniques.
Hernia Preparation
Open Hernia Repair
1
Skin incision.
4
2
Splitting of the Externusaponeurose.
3
Protection of the nerves.
5
The preparation of the hernia
is an important step and the
following techniques are based
on the approach explanation
of this page.
Preparation of the Musculus cremaster.
Preparation of the herina sac.
5
Bassini Technique
Open Reparation of Inguinal Hernias
1
The inguinal canal after ligation and
resection of the hernial sac.
4
2
Starting the suture near the pubic crest.
5
3
Loose stitches comprising the inguinal
ligament, transversalis fascia, transverses abdominis muscle and internal
oblique muscle.
A series of suture lines is used to reinforce the posterior
wall of the inguinal canal and narrow the internal inguinal
ring by the “triple layer” (transversalis fascia, transverses
abdominis muscle and internal oblique muscle) is sutured
to the inguinal ligament.
Advantages:
Finished repair.
6
Closure of external oblique aponeurosis.
The operation can be performed under local
anesthesia
Can be performed in growing patients, pregnant
women and women who may become pregnant
Shouldice Technique
Open Reparation of Inguinal Hernias
1
Opening the transversalis fascia at the
level of the inguinal canal.
2
3
First line of suture
Second line of suture
Pubic crest – deep inguinal ring – pubic
crest. This running suture approximates
the iliopubic tract to the aponeurosis of
the transverses abdominis muscle, including the transversalis fascia.
Unlike Bassini’s all layer interrupted suture, the Shouldice approach to
repairing the posterior wall of the inguinal canal begins at the level
of the transversalis fascia.
The transversalis fascia is divided parallel to the inguinal ligament,
and a double layer of transversalis fascia is sutured to the inguinal
ligament, using continuous suture lines. This is reinforced by an additional continuous double layer of low-tension suture which is placed
between the internal oblique muscle and the lower part of the inguinal
ligament.
4
Deep inguinal ring – pubic crest – deep
inguinal ring. This running suture approximates the internal oblique muscle to
the inguinal ligament.
Closure of external oblique aponeurosis.
Advantages:
The operation can be performed under local
anesthesia
Double layer low-tension suture
7
Lichtenstein Technique
Open Tension Free Method
2
1
Mesh fixation to the inguinal ligament.
Mesh fixation to the inguinal ligament.
6
5
The lower edges of the two tails are
sutured to the inguinal ligament to
create a new initernal ring comprised
of mesh.
Closure of external oblique aponeurosis.
In this procedure, which uses a conventional anterior approach, a polypropylene mesh is implanted between the external aponeurosis and the
internal oblique muscle to form a strong posterior wall of the inguinal
canal.
Advantages:
Tension free
The operation can be performed under local anesthesia
8
3
4
Mesh fixation to the internal oblique
muscle.
Spermatic cord is placed between the
two tails of the mesh.
Technique:
The medial end of the mesh is cut to the shape of the medial
corner of the inguinal canal (Optilene® Pre-shaped Mesh can
also be used). The rounded corner is sutured, with a nonabsorbable monofilamented suture material, to the anterior rectus
sheath above the pubic bone and overlapping the rectus sheath
by 1 to 1.5 cm. This suture is continued to attach the lower edge of the mesh to the inguinal ligament up to a point just lateral to the internal ring.
A slit is made at the lateral end of the mesh, creating two tails.
The upper edge of the mesh is sutured in place with two interrupted absorbable sutures, one to the rectus sheth and the
other to the internal oblique aponeurosis just lateral to the
internal ring.
Using a single nonabsorbable monofilamented suture the lower
edges of each of the completion knot of the lower running
suture. This creates a new internal ring made of mesh.
Plug Technique
Tension Free Method (Rutkow – Robbins)
1
2
3
Placement of a reinforcement mesh in
the inguinal canal that through an
aperture allows passage of the spermatic cord. This opening in the mesh is
sutured.
The rest of the mesh is left unfixed.
Placing the plug at the deep inguinal
ring.
Inserting and fixing the plug in the
deep inguinal ring.
In this open tension free treatment the hernia sac is pushed
back to abdominal cavity with a Premilene® Mesh Plug and
the defect is filled perfectly.
Due to the unique technique, the use of the plug is simple.
The plug is applied following the PIS technique (Position,
Insert, Stabilize).
Advantage:
The operation can be performed under local
anesthesia
9
TAPP Technique
(TransAbdominal PrePeritoneal)
Laparoscopic Inguinal Hernia Repair
1
Creating the peritoneal flap.
2
Dissecting the hernia sac.
During this hernia treatment, the posterior wall of inguinal
canal will be strengthened with an endoscopically placed
polypropylene mesh between the musculature of the abdominal wall and the peritoneum through a transabdominal
entrance.
The operation process takes place in the abdominal cavity.
3
Inserting and fixating the mesh.
Advantages:
Minimal invasive
Attendance of bilateral hernias at the same time
through one incision
For large and recurrent hernias
TAPP is a tension free method, strengthening the posterior
wall of the inguinal canal and all potential hernia sites in
the groin with a laparoscopically placed polypropylene
mesh into the preperitoneal space.
The access is transabdominal, through abdominal cavity.
10
Reinforcement of the abdominal wall and closure
of the hernia opening from the proper side (where
the pressure comes from), thus enabling immediate
postoperative physical work load
TEP Technique
(Totally ExtraPeritoneal Technique)
Laparoscopic Inguinal Hernia Repair
1
A incision of 2 cm is made on the anterior rectus
sheath, off the midline (on the affected side). Using a
finger and blunt dissection, a tunnel is created and
the HERLOON single use ballon is inserted.
4
2
3
Dilatation under visual monitoring to create working
space between the abdominal wall and the peritoneum (HERLOON ballon).
Insert the visualization trocar with cone.
In this reparation method, a whole operation takes places outside the abdominal
cavity. A balloon trocar (e.g. Herloon system) is used to create a working space
between the abdominal wall and the peritoneum.
5
The posterior wall of inguinal canal is
strengthened with an endoscopically
placed polypropylene mesh between the
musculature of the abdominal wall and
the peritoneum.
The balloon trocar is then replaced by a trocar with a
special sealing cone (mini-laparotomy trocar).
The polypropylene mesh (e.g.: Optilene® Mesh LP) is
inserted.
Advantages:
Minimal invasive
Attendance of bilateral hernias at the same
time through one incision
Peritoneum won’t be incised
Avoid bowel ingury
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Incisional and Umbilical Hernia
Description:
Treatment:
The other significant hernia types are the incisional and
the umbilical hernias.
There are three kinds of incisional and umbilical hernia
treatment with meshes:
Incisional hernias are caused by thinning or
stretching of scar tissue that forms after surgery.
This weakened scar tissue then creates a weakness
in the abdominal wall. Because of this weakness,
the hernia can occur during abdominal strain.
Umbilical hernias develop in and around the area
of the umbilicus.
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Onlay
Sublay
IPOM (IntraPeritoneal Onlay Mesh)
On the following page the description of these techniques
can be found.
Onlay Technique
The mesh is placed on the Rectus sheath
(abdominis) with open technique.
Sublay Technique
In this open or laparoscopic technique, the mesh
will be placed intraperitoneal.
IPOM
(IntraPeritoneal Onlay Mesh)
In this endoscopic hernia attendance, the mesh
will be placed intra-peritoneal onlay with transabdominal approach.
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Optilene® Mesh
Universal-light mesh for inguinal and
incisional hernia repair
Optilene® Mesh is a universal-light mesh, which
combines a lightweight concept with an excellent
handling. It is a soft, large pore and elastic mesh –
at the same time it is a strong mesh with excellent spread characteristics. The blue guidelines allow for a well directed placement. The mesh can
be used for inguinal and incisional hernia repair. It
provides optimal handlich for open and laparoscopic application. Optilene® Mesh is suitable for all
hernia repairs.
Advantages
Material:
Construction:
Weight:
Pore size:
■ Universal-light mesh
Monofilament Polypropylene
Knitted
60g/m2
1.5 mm
■ Large pores
■ Blue guidelines
■ Filament-reinforced
■ Soft, convenient and strong
■ Fully transparent
■ Homogenous elasticity
■ Open and laparoscopic procedures
Indication
■ Inguinal Hernia
■ Incisional Hernia
■ Reconstruction of chest wall
Content / Box
Cat. No.
5 x 10 cm
5 pieces
1065020
7.5 x 15 cm
5 pieces
1065030
Size
14
10 x 15 cm
5 pieces
1065040
26 x 36 cm
5 pieces
1065060
15 x 15 cm
5 pieces
1065080
30 x 30 cm
5 pieces
1065090
4.5 x 10 cm
5 pieces
1065140
6 x 14 cm
5 pieces
1065150
Shape
Optilene® Mesh LP
Super-light and fully transparent
Optilene® Mesh LP is a super-light 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 movements of the patient resulting
from body motion.
Optilene® Mesh LP offers extreme dimensional
stability as well as full transparency so that the
tissue underneath is visible during surgery.
Material:
Construction:
Weight:
Pore size:
Monofilament Polypropylene
Knitted
36g/m2
1 mm
Advantages
■ Super-light Polypropylene
■ Large pores
■ Soft and pliable
■ Fully transparent
■ Thin and comformable
■ Flexible, strong and secure
■ Ideal for inguinal hernia repair
■ Easy placement
Indication
■ Inguinal Hernia
■ Incisional Hernia
■ Reconstruction of chest wall
Size
Content / Box
Cat. No.
5 x 10 cm
5 pieces
1064735
7.5 x 15 cm
5 pieces
1064715
10 x 15 cm
5 pieces
1064725
15 x 20 cm
5 pieces
1064855
15 x 15 cm
5 pieces
1064705
4.5 x 10 cm
5 pieces
1064765
6 x 14 cm
5 pieces
1064775
Shape
For more information: www.optilene.com
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Optilene® Mesh Elastic
Elastic Lightweight and Large Pore Mesh
Optilene® Mesh Elastic is a lightweight and large
pore polypropylene mesh. Due to the multidirectional elasticity the mesh is able to adapt
to all movements taking place in the abdominal
wall. The new honeycomb like structure with
the large pores enables for ideal healing and
formation of an elastic scar.
Material:
Construction:
Weight:
Pore size:
The mesh is ideal for incisional hernia repair and
can also be used to repair inguinal hernias.
Optilene® Mesh Elastic helps for maintaining an
excellent abdominal wall physiology and results
in highest patient convenience.
Monofilament Polypropylene
Knitted
48g/m2
3.6 x 2.8 mm
Advantages
■ High patient convenience
■ Ideal for incisional hernia repair
■ Multidirectional elasticity
■ Lightweight mesh
■ Large pores
■ Monofilament structure
■ Excellent handling
Indication
■ Inguinal Hernia
■ Incisional Hernia
■ Reconstruction of chest wall
Size
Content / Box
Cat. No.
30 x 30 cm
5 pieces
1064900
15 x 15 cm
5 pieces
1064910
20 x 30 cm
5 pieces
1064940
10 x 15 cm
5 pieces
1064920
7.5 x 15 cm
5 pieces
1064930
Shape
For more information: www.optilene.com
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Omyra® Mesh
Prevention means Comfort.
Reducing adhesions, Impairing Bacterial Growth.
Omyra® Mesh is the first bacterial resistant antiadhesive mesh. Omyra® Mesh brings a new concept
for hernia repair. It is made of light-weight
condensed Polytetrafluoroethylene (cPTFE) and a
Star-Macroporous structure improves the adhesion
prevention features of the traditional expanded PTFE
and enhances the tissue integration achieved with
Polypropylene meshes. The CondensTech, transparent
monolayer Omyra® Mesh provides the best handling,
specially in laparoscopic procedures.
Advantages
Characteristic: cPTFE
Composition: Micromachined condensed
Polytetrafluoroethylene
Structure:
Monolayer
Density:
0.9 g/cm2
Pore size:
2.4 mm (Star shape)
■ Impairment of Bacterial Growth
■ Reduction of Adhesion Formation
■ Avoidance of Seroma
■ Highly Biocompatible
■ Optimal handling features
Indication
■ Incisional Hernia
■ Inguinal Hernia
Size
Content / Box
Cat. No.
26 x 36 cm
1 piece
1062636
20 x 30 cm
1 piece
1062030
15 x 22 cm
1 piece
1061520
11 x 15 cm
1 piece
1061115
14 x 14 cm
1 piece
1061414
15 x 15 cm
1 piece
1061515
10 x 15 cm
1 piece
1061015
7.5 x 15 cm
1 piece
1060715
6 x 11 cm
1 piece
1060611
Shape
Porous Shape
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Premilene® Mesh
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, large pore 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 a highly transparent so that
tissue underneath is visible during surgery.
Material:
Construction:
Weight:
Pore size:
Monofilament Polypropylene
Knitted
82g/m2
0.8 mm
Advantages
■ Rapid healing and tissue penetration
■ Ideal Pore size
■ Thinmesh structure
■ Excellent transparency
■ Good handling
■ Well tolerated
■ Good stability
Size
Content / Box
Cat. No.
3 x 10 cm
5 pieces
1064305
■ Inguinal Hernia
5 x 10 cm
5 pieces
1064315
■ Incisional Hernia
7.5 x 15 cm
5 pieces
1064425
10 x 15 cm
5 pieces
1064495
5 x 30 cm
5 pieces
1064445
26 x 36 cm
5 pieces
1064465
7.5 x 7.5 cm
5 pieces
1064415
15 x 15 cm
5 pieces
1064435
30 x 30 cm
5 pieces
1064455
4.5 x 9.5 cm
5 pieces
1064325
5 pieces
1064335
4.5 x 10 cm
5 pieces
1064345
6 x 14 cm
5 pieces
1064365
4.5 x 10 cm
5 pieces
1064385
6 x 14 cm
5 pieces
1064375
6 x 12.5 cm
Shape
For more information: www.bbraunmeshes.com
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Indication
■ Reconstruction of chest wall
Premilene® Mesh Plug
Polypropylene mesh for plug technique
Premilene® Mesh Plug is designed for the repair of
recurrent hernias and can also be used for primary
inguinal hernias. The smooth self-expanding plug
fills the defect perfectly. The Plug adapts optimally
to the shape of the defect and the natural anatomy.
Premilene® Mesh Plug is a pre-shaped mesh with
excellent properties: Rapid healing and tissue penetration, high biocompatibility and stability. It is able
to conform to the movements of the patient.
Advantages
Material:
Construction:
Weight:
Pore size:
■ Most anatomic 3-D shape
Monofilament Polypropylene
Knitted
82g/m2
0.8 mm
■ Smooth plug design
■ Blunt tip
■ Exclusive blue center grip
■ Full range of plug depths
■ Pre-shaped mesh onlay
Indication
■ Inguinal Hernia Repair
■ Incisional Hernia Repair
Description
Dimensions
Form
Plug
flat
Contents
Article No.
Plug
Onlay
shaped
Premilene® Mesh Plug Plug Depth - 2.5 cm
Small
Onlay - 5 x 10 cm
with small onlay
5/Box
1064605
Premilene® Mesh Plug Plug Depth - 3.25 cm
Medium
Onlay - 5 x 10 cm
with small onlay
5/Box
1064615
Premilene® Mesh Plug Plug Depth - 3.75 cm
Large
Onlay - 5 x 10 cm
with small onlay
5/Box
1064625
Premilene® Mesh Plug Plug Depth - 4.5 cm
Extra Large
Onlay - 5 x 10 cm
with small onlay
5/Box
1064635
19
Absorbable Sutures
Safil®
■
20
Mid-term absorbable
Monosyn®
■
Mid-term absorbable
Chemical Composition:
Polyglycolic acid
Chemical Composition:
Glyconate
Structure:
Braided
Monofilament
Structure:
Monofilament
Colour:
violet or undyed
Colour:
violet or undyed
Sizes:
braided: USP8-0 - USP2
monofilament: USP10-0 - USP9-0
Sizes:
USP7-0 - USP1
Absorption Time:
1. day 100 %
18. day 50 %
21. day 40 %
Absorption Time:
1. day 100 %
14. day 50 %
21. day 20 %
Complete Absorption:
from 60 to 90 days
Complete Absorption:
from 60 to 90 days
Indication:
■ Gastrointestinal surgery
■ Gynaecology / obstetrics
■ Ophthalmic surgery
■ Orthopaedics
■ Urology
■ Skin closure (intra, sub, skin)
■ Neurosurgery
■ Ligatures
Indication:
■ Gastrointestinal surgery
■ Gynaecology / obstetrics
■ Urology
■ Plastic and reconstructive surgery
■ Skin closure (intra, sub, skin)
■ Ligatures
Advantages:
■ High tensile strength
■ Excellent knotting ability
■ Smooth passage through tissue
■ Easy handling
Advantages:
■ Superior initial knot tensile strength
■ Ideal degradation profile for soft tissues
■ Smooth tissue passage
■ Excellent knot security
■ Quick mass absorption
MonoPlus®
■
Long-term absorbable
MonoMax®
■
Long-term absorbable
Chemical Composition:
Polydioxanone
Chemical Composition:
Poly-4 Hydroxybutyrate
Structure:
Monofilament
Structure:
Monofilament
Colour:
violet
Colour:
violet
Sizes:
USP7-0 - USP2
Sizes:
USP 1(metric 4), USP 0 (metric 3.5)
and USP 2/0 (metric 3)
Absorption Time:
1. day 100 %
14. day 90 %
28 - 35 days 50 %
Absorption Time:
1. day 100 %
90 days 50 %
Complete Absorption:
from 180 to 210 days
Complete Absorption:
after 180 days
Indication:
■ Abdominal wall closure
■ Orthopaedics
■ Paediatric cardiovascular surgery
Indication:
■ Abdominal wall closure
Advantages:
■ High knot tensile strength
■ Outstanding strength retention for extended
wound support
■ Very flexible
■ Pliable and easy to knot
■ Conveniently elongable
■ Smooth passage through tissue
Advantages:
■ High knot tensile strength
■ Outstanding strength retention for extended
wound support
■ Very flexible
■ Pliable and easy to knot
■ Conveniently elongable
■ Smooth passage through tissue
21
Non-Absorbable Sutures
Premilene®
■
22
Non-absorbable
Dafilon®
■
Non-absorbable
Chemical Composition:
Polypropylene
Chemical Composition:
Polyamide 6 and 6.6
Structure:
Monofilament
Structure:
Monofilament
Colour:
blue
Colour:
blue / undyed / black
Sizes:
braided: USP10-0 - USP1
Sizes:
braided: USP11-0 - USP1
Indication:
■ Vascular surgery
■ Cardiac surgery
■ Plastic and reconstructive surgery
■ Skin closure (intra, sub, skin)
■ Neurosurgery
■ Microsurgery
■ Gastrointestinal surgery
Indication:
■ Skin closure (intra, sub, skin)
■ Plastic and reconstructive surgery
■ Microsurgery
■ Ophthalmic surgery
■ Neurosurgery
Advantages:
■ Smooth passage through tissue
■ Excellent knot run down and security
■ Minimal acute inflammatory reaction in tissues
■ Unsurpassed strength
■ Optimal elasticity and elongation properties
Advantages:
■ High tensile strength
■ Excellent knotting ability
■ Smooth passage through tissue
■ Easy handling
Skin Stapler and Tissue Adhesive
Manipler® AZ
Histoacryl®
Chemical composition:
Enbucrilate
Staple Information:
Type: Wide
No: 35
Colour:
blue, translucent
Staple Dimension:
Crown: 6.9 mm
Leg.: 3.6 mm
Sizes:
■ 0.5 ml
Indication:
■ Thoracic surgery
■ Cardiac- and vascular surgery
■ General surgery
■ Gynaecology / Urology
■ Orthopaedics
Indication:
■ Closure of minor skin wounds without suturing
■ Sclerosation Therapy
Advantages:
■ Grip designed for best angle
■ Automatic clip ejection
■ Box-style staple
■ Ease of use
Advantages:
■ Excellent cosmetic results
■ High mechanical strength
■ Short duration of treatment
■ Low medical fees
■ Local anaesthetic is not required
■ Avoids additional trauma (suture hole stitches)
■ No removal of sutures required
■ Effective protection against bacteria infection
(adhesive film)
■ Over 30 years of clinical experience
■ Storage at room temperature
23
Recommended materials
Absorbable Sutures
Name
Sizes
Needle length
Cat. No.
Indication
Safil
USP 2-0
HR17
C1048015
for Peritoneum suture
®
Safil
USP 2-0
HR22
C1048031
for Peritoneum suture
Safil®
USP 2-0
HR37s
C1048095
for Closure of External aponeurosis
Safil®
USP 3-0
HR26
C1048041
for Subcutaneous suture
Safil®
USP 2-0
JRC30
C1048483
for Fascia suture in the TAPP technique
Safil®
USP 0
JRC30
C1048482
for Fascia suture in the TAPP technique
Monosyn®
USP 4-0
DSMP19
C0023624
for Skin closure
Monosyn
USP 3-0
DSMP24
C0023633
for Skin closure
MonoPlus®
USP 4-0
HR26
C0024024
for Peritoneum suture in TAPP technique
MonoPlus®
USP 4-0
GR19
C0024984
for Peritoneum suture in TAPP technique
MonoPlus®
USP 1
HRT48 loop
C0024394
for Abdominal Wall Closure
MonoMax®
USP 1
HRT48 loop
B0041241
for Abdominal Wall Closure
MonoMax®
USP 0
HRT48 loop
B0041240
for Abdominal Wall Closure
Sizes
Needle length
Cat. No.
Indication
Premilene®
USP 4-0
DSMP19
C0090676
for Skin closure
Premilene
®
USP 3-0
DSMP24
C0090656
for Skin closure
Premilene®
USP 2-0
HR26
C0090042
for Mesh fixating
Premilene®
USP 2-0
HR26s
C0095442
for Multilayer interrupted suture in
®
®
Non-Absorbable Sutures
Name
Bassini technique, for transversalis
duplication in Shouldice technique,
for fixation the muscles to inguinal
ligament in Shouldice technique
Premilene®
USP 0
HR26s
C0095443
for transversalis duplication in
Premilene®
USP 0
HR37s
C0090152
for transversalis duplication in
Dafilon®
USP 4-0
DSMP19
C0936235
for skin closure
Dafilon
USP 3-0
DSMP24
C0936316
for skin closure
Sizes
Information
Cat. No.
Indication
Manipler®AZ
6.9 / 3.6 mm
W35
783100
for skin closure
®
Histoacryl
0.5 ml
10 ampoules
1050044
for skin closure (blue)
Histoacryl®
0.5 ml
10 ampoules
1050071
for skin closure (translucent)
Shouldice technique
Shouldice technique
®
Skin Stapler, Tissue Adhesive
Name
24
General Surgery
Basic Instrument Set
For Open Hernia Treatments
Name
No.
Cat. No.
Maier Sponge Forceps, curved, 265 mm
2
BF059R
Backha Towel Clamp, 110 mm
4
BF432R
Towel Clamp for Paper Cloths 115 mm
2
BF465R
Scalpel Handle, fitting no. 4 for blades 18 - 37
2
BB084R
Scalpel Handle #3, fitting no. 3 for blades 10 - 15 and 40, 42
1
BB073R
Metzenbaum Durotip® Dissecting Scissors, curved, 180 mm
1
BC271R
Durotip Ligature Scissors, serrated, curved, 180 mm
1
BC295W
Mayo-Lexer Durotip® Dissecting Scissors, curved, 165 mm
1
BC284R
Surgical scissors, straight, blunt / sharp, 145 mm
1
BC324R
Dissecting Forceps, medium, 145 mm
1
BD027R
Tissue Forceps, 1 X 2 teeth, medium,145 mm
2
BD537R
®
De Bakey Atraumata Dissecting Forceps, 2,0 mm wide, 150 mm
2
FB400R
Kocher Haemastatic Forceps, 1 X 2 teeth, straight, 140 mm
6
BH614R
Pean Haemastatic Forceps, straight, 140 mm
6
BH424R
Halsted – Mosquito Haemastatic Forceps, curved, 125 mm
6
BH111R
Kocher – Ochser Haemastatic Forceps, straight, 200 mm
2
BH646R
®
Maier Sponge Forceps, straight, 265 mm
2
BF058R
Mikulicz Peritoneum Forceps, 205 mm
4
BJ314R
Overholt Dissecting Forceps, fine pattern, figure 1, 210 mm
2
BJ081R
Overholt Dissecting Forceps, fine pattern, figure 2, 220 mm
2
BJ082R
Deschamps Ligature Needle, curved to left, 215 mm
1
BM810R
Koenig Guiding Probe, 5 mm, 195 mm
1
BM901R
Crile-Wood Durogrip®
1
BM016R
Hergar – Mayo Durogrip® needleholder, 205 mm
2
BM067R
De Bakey Durogrip needleholder, 180 mm
1
BM035R
Roux Retractor, double ended, set of 3, 165 mm
1
BT030R
®
Langenbeck Retractor, 33 X 14 mm, 210 mm
2
BT322R
Interior Box, for BL 930, round
1
BL931R
Laboratory dish 0.16 l
1
JG522R
Laboratory dish 0.4 l
1
JG523R
Kidney tray stainless steel 250 mm
1
JG506R
Redon Spike Ch. 12 Slig. CVD. triang. tip
1
BN944R
Redon Spike Ch. 14 Slig. CVD. triang. tip
1
BN945R
25
Endoscopy Basic Set
*only for the TEP technique
For more information: www.endoscopy-catalog.com
Name
Cat. No.
No.
Metzenbaum Scissors, serrated
PO004R
1
Hook Scissors, blunt
PO001R
1
Maryland Fixation / Dissection Forceps
PO102R
1
Atraumatic Fixation / Dissection Forceps
PO101R
1
Delicate Dissecting Forceps
PO151R
1
Pike-Mouth Forceps
with reservoir in the jaw
PO107R
1
Durogrip Needle Holder, straight
or
PL407R
1
Durogrip Needle Holder, left curved
PL408R
1
or
26
Name
Cat. No.
HERLOON System
The Herloon hernia sytem has two components
No.
1
Component 1:
EJ871R
Reusable Trocar Body*
Trocar body for EJ870P with blunt obturator 10/300 mm
Component 2:
Single Use Balloon Shaft with Hand Pump*
10 pieces, individual sterile packaging
EJ870P
Trocar for Mini-Laparotomy
10/110 mm, w. stopcock
Consisting of EK024R, EK086P, EK098R, EK064R
1
Trocar Sleeve
5/110 mm, smooth, w/o stopcock
EK015R
1
Sealing unit
5 mm
EK080P
1
Conical Sharp Trocar Pin
5/110 mm
EK046R
1
Trocar Sleeve
10/110 mm, smooth, w. stopcock
EK024R
2
Sealing unit
10 - 12 mm, with 5 mm flap converter
EK083P
2
Conical Sharp Trocar Pin
10/110 mm
EK056R
1
Reduction Sleeve
10 to 5 mm
EK090R
2
Full HD Laparoscope
10 mm / 0°
or
PE889A
1
Full HD Laparoscope
10 mm / 30°
PE909A
1
27
B. Braun Surgical SA | Carretera de Terrassa, 121 | 08191 Rubí | Spain
Phone +34 93 5 86 62 00 | Fax +34 93 6 99 73 03 | www.bbraun.es
Aesculap AG | Am Aesculap-Platz | 78532 Tuttlingen | Germany
Phone +49 (0) 74 61 95-0 | Fax +49 (0) 74 61 95-26 00 | www.aesculap.com
Aesculap – a B. Braun company
All rights reserved. Technical alterations are
possible. This leaflet may be used for no other
purposes than offering, buying and selling of
our products. No part may be copied or reproduced in any form. In the case of misuse we
retain the rights to recall our catalogues and
pricelists and to take legal actions.
Brochure No. B47102
1109/1/1