International Partner Meeting 2013 / WE 1 A.M.I. ™HexaPro Mesh What a market? What an opportunity on hand?

International Partner Meeting 2013 / WE 2 A.M.I. ™HexaPro Mesh An estimated 1,5 Million abdominal hernia repairs are performed each year in Europe An estimated 75% of which are inguinal hernia repairs. The lifetime prevalence of inguinal hernias is between 10% and 15% for men and 2% for women. The landscape of hernia repair techniques and prosthetics has expanded over the past 2 decades and continues to evolve. Surgeons have a wide variety of open and laparoscopic techniques at their disposal. Ninety percent of procedures now use mesh prosthesis (as opposed to primary tissue repair with sutures). At this time, no operative technique has emerged as the clear choice for all inguinal hernias.

International Partner Meeting 2013 / WE 3 A.M.I. ™HexaPro Mesh Worldwide Synthetic Mesh Market US Market Research / Published 2012 by PolyPro Mesh Start up Company! Current Global Hernia Mesh Repair Mesh Units Current Global Groin Hernia Mesh Repair Average Selling Price US$ / Unit Current Global Groin Hernia Mesh repair Mesh Market US$ Other type of hernias…. Current Global Paraumbilical Hernia Mesh Repair Units Current Global Epigastric Hernia Mesh Repair Units Current Global Other Hernia Mesh Repair Units Current Global Incisional Hernia Mesh Repair Units Let’s us ask some questions here? Why do you think, StartUp Companies looking at improved mesh technologies do still find millions of $ of Venture Capital? Why do private investors still invest in a such a highly competitive market, with 50+ companies world wide fighting for market shares?

International Partner Meeting 2013 / WE 4 A.M.I. ™HexaPro Mesh Worldwide Synthetic Mesh Market US Market Research / Published 2012 by PolyPro Mesh Start up Company!

International Partner Meeting 2013 / WE 5 A.M.I. ™HexaPro Mesh Despite the low recurrence rates found with placement of large prosthetic in the pre-peritoneal space, less than 30% of all inguinal hernias are repaired laparoscopically in EUROPE, and even less than 25% in the ROW, including the US! However, in many instances recurrent hernia, bilateral hernias, etc… the laparoscopic approach is viewed as ideal! Techniques currently used for laparoscopic repair of inguinal hernia TAPP & TEP Procedure were developed in the early 1990s……..thus 20 years ago!

International Partner Meeting 2013 / WE 6 A.M.I. ™HexaPro Mesh Most common laparoscopic inguinal hernia repair procedures? TEP: In the TEP approach, the preperitoneal space is accessed via an infra- umbilical incision. TEP approach may not be possible in patients who have peritoneal scarring from previous surgery. TEP: if large tears in the peritoneum occure, conversion to TAPP approach is necessary.

International Partner Meeting 2013 / WE 7 A.M.I. ™HexaPro Mesh Most common laparoscopic inguinal hernia repair procedures? TAPP: The peritoneal (abdominal) cavity is entered via an incision at the umbilicus, where a 10mm trocar is placed. Two 5mm trocars are placed on each side of the abdomen, just lateral to the epigastric vessels. The peritoneum is incised several centimeters above the hernia defect. The peritoneum is bluntly (Bluntdissect – DLU!!) stripped down from the abdominal wall proceeding medially until Cooper’s Ligament is identified. A large 12x15 or 15x15 cm A.M.I. HEXAPRO MESH is placed in the preperitoneal space and secured to Cooper’s Ligament with tacks, glue or sutures. The peritoneum is then closed back over the mesh, using tacks, glue or sutures.

International Partner Meeting 2013 / WE 8 A.M.I. ™HexaPro Mesh Most common non laparoscopic inguinal hernia repair procedure by means of a mesh? LICHTENSTEIN Procedure: This is the most commonly performed inguinal herniaraphy. A.M.I. HEXAPRO Mesh is used to bridge the defect in the inguinal floor, it is not necessary to approximate tissues that are not naturally in apposition (tension free repair)! FYI: More than 70 named hernia repair approaches have been described in the literature. Many are relatively minor modifications of other approaches. You may run into procedures names, such as: Plug&Patch, Read_Rives, Wantz, Stoppa, Kugel, McVay, Ugahary and others…..just keep in mind………all these procedure do play a very minor role in the treatment hernias.

International Partner Meeting 2013 / WE 9 A.M.I. ™HexaPro Mesh Commonly Used Methods for Inguinal Hernia Repair NameYearDescription Mesh-Free Approaches Bassini1890Open anterior approach, fixation of the m. obliquus internus, m. transversus abdominus and the fascia transversalis to the inguinal ligament McVay Cooper Lig. Repair1942Open anterior approach, Fixation of the m. Obliquus internus, m. transversus abdominus and the fascia transversalis to the Cooper’s ligament. Shouldice Operation1945Open anterior approach, doubling running suture of the fascia transversalis and doubling suture of the M. obliquus internus to the inguinal ligament. Mesh –Based Approaches Rives1965Open posterior approach, trans-inguinal preperitoneal meshplasty Stoppa1968Open posterior approach with mesh, bilateral hernias Lichtenstein1970Open anterior approach with mesh, implantation of mesh behind the aponeurosis of the m. obliquus externus (onlay patch)! Wantz1989Open posterior approach with mesh; unilateral hernia TAPP1991Laparoscopic posterior approach with mesh, transabdominal preperitoneal meshplasty TEP1991Laparoscopic posterior approach, total extraperitoneal meshplasty

International Partner Meeting 2013 / WE 10 A.M.I. ™HexaPro Mesh Commonly Used Methods for Inguinal Hernia Repair 2012 Data available from the German Hernia Society: Germany:82 Mio. Population Total Inguinal Hernia Repairs: cases / year (approx. 335 Cases / Mio. Pop.) Percentage of recurrency procedures: 10 to 15% Total Number of lap. hernia repair: cases / year 28% of cases, ( growing…..) Most common performed procedures: Primary Repair % of all cases Recurrency Repair % of all cases Bassini0,30,4 Shouldice3,93,3 Hernia Sack Closure0,10,2 Plug4,66,4 Lichtenstein23,431,2 Gilbert und TIPP3,94,4 TAPP38,534,8 TEP22,316,2 Others3,03,2 HexaPro Mesh perfect for 84,2% of all laparoscopic conducted inguinal hernia repairs in Germany! HexaPro Mesh perfect for 83,2% of all laparoscopic conducted inguinal hernia recurrency repairs in Germany!

International Partner Meeting 2013 / WE 11 A.M.I. ™HexaPro Mesh Commonly Used Methods for Inguinal Hernia Repair 2012 Data available from the German Hernia Society: Germany:82 Mio. Population Total Inguinal Hernia Repairs: cases / year (approx. 335 Cases / Mio. Pop.) Percentage of recurrency procedures: 10 to 15% Total Number of lap. hernia repair: cases / year 28% of cases, ( growing…..) HexaPro Business Potential in Germany 2012: HexaPro Mesh 15 x15 could be applied in 85% of all laparoscopic hernia repairs: Cases / year HexaPro Meshes per year! or approx EURO in sales (assuming a low retail price of 35,- EURO / Unit). Business potential for HexaPro Mesh 15 x 15cm: ,- EURO / Mio. Pop.

International Partner Meeting 2013 / WE 12 A.M.I. ™HexaPro Mesh Which material, which mesh is best? The use of synthetic mesh for both inguinal and ventral hernia repairs has gained nearly universal acceptance among surgeons. Modern mesh products were first introduced in 1958 (Usher, et.al); today, the abundance of mesh products available makes it difficult for surgeons to understand the advantages, disadvantages and indications for each of the available options! A multitude of animal studies have been published evaluating synthetic mesh products for abdominal wall reconstruction. Drawing any firm conclusions as to the superiority of one product over another is not possible, as authors use various models with little clarity as to the definitions of the outcome measured (from literature surgeons cannot learn, which product is best)! Today, POLYPROPYLENE-based meshes are the most commonly used prosthetics worldwide for the repair of inguinal hernia!

International Partner Meeting 2013 / WE 13 A.M.I. ™HexaPro Mesh Commonly Used Polypropylene and/or Composite Mesh Systems for Inguinal Hernia Repair Brand NamesVendorDensity of Polypropylene in Mesh Average Knitting Pore Size Interstitial Pore Size Implant Thickness SurgiproCovidien110 g/m2< 1mmunknown0,57 mm Prolene (preshaped / precut)Ethicon105 g/m21-1,6mmunknown0,55 mm Bard Mesh / Bard Soft Mesh/Marlex / 3DMax / Visilex Davol / Bard80 – 95 g/m20,1 – 0,8 mm unknown0,66 – 1,5mm C-Qur (O3FA-absorbable tissue coating) Atrium85 g/m20,8mmunknown0,48 mm ProLite (preshaped, self forming plugs) Atrium85 g/m20,8 mmunknown0,48 mm ProLite UltraAtrium50 g/m20,75 mmunknown0,41 mm Prolene SoftEthicon45 g/m23 – 4mmunknown0,41mm Ultrapro (partially absorbable)Ethicon28 g/m23 – 4mmunknown0,5 mm Ti MeshGFE16 g/m2< 1mmunknown0,2 mm HexaProA.M.I.21 g / m22 mm micrometer 0, 3 mm

International Partner Meeting 2013 / WE 14 A.M.I. ™HexaPro Mesh Commonly Used Polypropylene and/or Composite Mesh Systems for Inguinal Hernia Repair US Market Trends: Surgeons prefer macroporous mesh over conventional microporous mesh Bilogics are unreliable and surgeons are tending back to macroporous polypropylene mesh, including those patients with pre-existing infections. Surgeons are suspect of ePTFE and Polyester Meshes for infection risk patients, they prefer polypropylene of biologics for these patients. FDA is focused on the incidence of chronic pain and device biocompatibility

International Partner Meeting 2013 / WE 15 A.M.I. ™HexaPro Mesh Complications? Recovery Time & Postoperative Pain! Studies have demonstrated that postoperative recovery following inguinal hernia repair is faster and postoperative pain is reduced when laparoscopic approaches and ultralight mesh implants are used. However, this does not result in a lower incidence of chronic postoperative groin pain with laparoscopic repair! Patients receiving a light weight mesh for inguinal hernia repair have less sensation of a foreign body in the groin and may feel less discomfort on exertion and active physical exercise! Can you imagine, how patients can benefit from our ultra light A.M.I. HexaPro Mesh, with it’s unique ISOELASTICITY, when implanted in the groin area? Persistent postop pain that fails to resolve 3 month post-surgery is classified as chronic pain. Two large studies from Sweden have investigated the incidence of long- term pain after inguinal hernia repair. Mild to moderate pain can occur in about 30% of patients, whereas severe pain that interferes with activities of daily living occurs in 3 to 6 % of patients! A surgeon carries - 3 to 6 % very unhappy, and - up to 30 % complaining patients hernia patients in his records! Can we help hernia surgeons to reduce such numbers?

International Partner Meeting 2013 / WE 16 A.M.I. ™HexaPro Mesh Complications? Recovery Time & Postoperative Pain! Mild to moderate pain can occur in about 30% of patients, whereas sever pain that interferes with activities of daily living occurs in 3 to 6 % of patients! How can we help? Isn’t this reason enough to ask hernia experts in your country, to compare the postoperative pain outcome of their patients in a personal trial of 100 patients, - 50 – the current used mesh implant is compared to - 50 – A.M.I. HexaPro Mesh applications! Postoperative pain after inguinal hernia repair, remains the most common complication and we believe, that our unique knitting pattern of the HexaPro Mesh, with its - large knitting pores (avoiding tissue bridging) - defined, very large interstitial pores (inducing fibroblast in-growth) - highest porosity ( reducing tissue reactions, enhancing smooth ingrowth) and its - ISOELASTICITY pattern, will reduce the percentage of pain sufferers after inguinal hernia repair, considerably!

International Partner Meeting 2013 / WE 17 A.M.I. ™HexaPro Mesh What else is needed to succeed in this battle for market share in this highly competitive market? What do we have on hand? A technological State of the Art Mesh Implant for use in inguinal hernia repair! Very competitive in price! Unique packaging, designed to support cost saving efforts of hospital administration! How to make it happen?