C Peiper

Evangelisches Krankenhaus Hamm, Hamm, North Rhine-Westphalia, Germany

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Publications (51)39.5 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Modern concepts for treating inguinal hernias always include prosthetic mesh repairs. Some surgeons use the mesh repair exclusively [1]. Reported results are promising concerning recurrence rates [2] and return to physical activity [3]. On the other hand, there is a certain risk of complications due to the mesh that are difficult to detect. Alterations of fertility, if observable, may be recorded only in very large series. We know that prosthetic meshes implanted into the abdominal wall cause chronic inflammatory changes of the surrounding tissue [4]. Because of the close contact between mesh and the structures of the spermatic cord after inguinal mesh repair, these changes may also alter the reproductive structures in male patients. Case reports have been published about spermatic granuloma [5] and spermatoceles [6] after Lichtenstein hernia repair. Especially after mesh implantation in younger patients, these findings may be of great importance.
    12/2009: pages 29-38;
  • Ch. Peiper, U. Klinge, V. Schumpelick
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    ABSTRACT: Zusammenfassung:Grundlagen: Qualittsparameter des postoperativen Verlaufs nach Reparation einer Leistenhernie sind die Rezidivrate auch im Langzeitverlauf, das Auftreten und die Höhe der postoperativen Schmerzen, die Ausbildung von Hmatomen und Wundinfektionen, mögliche Begleitverletzungen sowie die Dauer der Rekonvaleszenzphase. Methodik: Aktueller Stand der Literatur sowie eigene klinische und experimentelle Untersuchungen zur Hufigkeit und zur Vermeidung von Komplikationen in der Leistenhernienchirurgie werden referiert. Ergebnisse: Die Höhe der Komplikationsraten ist wesentlich von der Beachtung der korrekten Operationstechnik abhngig. Darüber hinaus üben die Wahl des geeigneten Materials bei Verwendung alloplastischer Meshes, patienteneigene Faktoren sowie das perioperative Management einen großen Einfluss auf die Ergebnisse aus. Schlussfolgerungen: Wir empfehlen zur Minimierung der Komplikationsrate das folgende Vorgehen: Die kleine primre Hernie des jüngeren Patienten mit niedriger Rezidivgefahr sollte einem meshfreien Nahtverfahren zugeführt werden. Bei einer großen direkten Hernie des lteren Patienten oder einer Rezidivhernie mit großem Re-Rezidivrisiko kann ein Netz-Verfahren angewandt werden. Bei der Auswahl des zu implantierenden Meshes sollte auf eine geringe Materialdichte geachtet werden.Complications in Inguinal Hernia SurgerySummary:Background: Endpoints of quality control in inguinal hernia surgery are recurrence rates, also in the long term follow-up, appearance and amount of postoperative pain, haematomas, wound infection, possible concomitant injuries and the duration of reconvalescence. Methods: Current publications as well as own clinical and experimental studies concerning frequency of complications in inguinal hernia surgery and how to avoid them are reported. Results: The level of complications rates depends mainly on the respect of correct operative technique. Moreover, the choice of adequate material, patient immanent factors as well as the perioperative management have great influence on the results. Conclusions: We recommend the following procedure to reduce the complication rates: The small primary hernia of the young patient with a small recurrency risk should be repaired using a suture technique. The large direct hernia of the elder patient or the recurrent hernia with a high risk of re-recurrency may be repaired by a mesh technique. If mesh implantation is required, it should be of low material weight.
    Acta Chirurgica Austriaca. 06/2008; 33(4):173 - 176.
  • C. Peiper, S. Schinkel, K. Junge
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    ABSTRACT: Many different therapeutic principles compete in the treatment of inguinal hernias. Due to their training, many surgeons prefer just one kind of inguinal hernia repair. Many institutions provide one single therapeutic principle in high volumes. Examples are the Shouldice Hospital in Toronto, which up to now has performed more than 270,000 suture repairs, while specialized laparoscopic clinics do more than 1000 laparoscopic repairs every year. This principle of doing one single operation at a high level of routine and standardization for any patient may lead to a good quality of the used procedure, but is not accepted everywhere. Due to great variations in patients concerning body constitution, size of the hernia or collagen metabolism, the idea of one operation suitable for all patients has to be discussed.
    12/2006: pages 391-396;
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    ABSTRACT: The aim of this study was to analyze and evaluate the long-term recurrence rate and risk factors for inguinal hernia recurrence in patients treated by the Shouldice suture repair. A total of 293 hernias treated by Shouldice suture technique in 1992 were studied retrospectively. After a 10-year follow-up, 15 potential risk factors for recurrence were assessed in 142 patients undergoing 171 Shouldice repairs. Recurrent hernias showed a significantly higher (22.0%) recurrence rate than primary inguinal hernias (7.7%). Furthermore, an age of more than 50 years, smoking, and the presence of two or more similarly affected relatives were found to be independent risk factors for recurrence. The present study underlines the importance of patient-related risk factors for the development of a recurrent inguinal hernia. Patients at risk should preoperatively be identified in order to improve treatment by, for example, the application of mesh techniques.
    Hernia 09/2006; 10(4):309-15. · 1.69 Impact Factor
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    ABSTRACT: To optimise the satisfaction of patients after repair of primary inguinal hernias under local anaesthesia, we analysed the analgetic power of Ropivacain in the postoperative period. One hundred consecutive patients underwent repair under local anaesthesia with the same volume of 0.75% Ropivacain or 1% Mepivacain in a randomised and blinded manner. Postoperative pain analysis was carried out in all patients. Subjective pain levels at rest and under stress as well as impairment by pain were found to be significantly lower in the Ropivacain group at the day of operation. Decrease in vital capacity and peak flow showed similar results. The postoperative amount of analgesics and time of mobilisation showed a positive influence by the use of Ropivacain. Ropivacain reduces postoperative pain levels after hernia repair. This leads to increased comfort for patients, without elevated perioperative risk.
    Der Chirurg 06/2005; 76(5):487-92. · 0.52 Impact Factor
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    ABSTRACT: Titanium and its alloys are used worldwide in surgery. The favorable characteristics that make this material desirable for implantation are corrosion resistance and biocompatibility. Concerning hernia repair, a mesh modification has been developed using titanium layering of a polypropylene mesh implant, which is said to lead to an improved biocompatibility compared to commercially available mesh materials. To analyze the pure effect of titanium coating, two different mesh structures were studied using a standardized animal model. The titanium-coated monofilamentous, large porous, and lightweight mesh made of polypropylene and coated with titanium (PP+T) was compared to a pure polypropylene mesh manufactured with a similar structure and amount of material serving as a control (PP). In Sprague-Dawley rats, mesh samples were placed in a subcutaneuous position. Then 56, 84, and 182 days after mesh implantation, three animals from each group were sacrificed for morphological observations (amount of inflammatory and connective tissue formation, percentages of proliferating and apoptotic cells, percentage of macrophages). Both mesh modifications investigated showed an overall good biocompatibility. Macroscopic clinical observation after implantation of up to 182 days was uneventful. The tissue response to the PP as well as to the PP+T mesh was characterized by a moderate inflammatory tissue reaction limited to the perifilamentary region as is known for low weight, large porous, and monofilamentous mesh structures. No significant improvement of biocompatibility was found when analyzing the effect of titanium coating compared to the pure polypropylene mesh structure.
    Hernia 06/2005; 9(2):115-9. · 1.69 Impact Factor
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    ABSTRACT: Zusammenfassung
    Der Chirurg 05/2005; 76(5):487-492. · 0.52 Impact Factor
  • Viszeralchirurgie 01/2005; 40(5):325-330. · 0.06 Impact Factor
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    ABSTRACT: This anatomical study investigated the connection of the muscles of the abdominal wall to the transversalis fascia in the groin. In six unfixed male corpses we prepared the single levels of the inguinal abdominal wall and examined their interrelationships. Of special interest were the direction of the force vectors determined by the direction of the muscular fibers in relation to the transversalis fascia. We found no confirmation of a direct connection between the muscles of the abdominal wall and the transversalis fascia in the inguinal region. No force vector of the different muscular layers points away from the triangle of Hesselbach. By contraction each muscle thus relaxes the transversalis fascia of the Hesselbach triangle.
    Hernia 01/2005; 8(4):376-80. · 1.69 Impact Factor
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    ABSTRACT: We report a case of postoperative ileocecal invagination in a 63-year-old male. Forty-six days after esophageal resection and gastric tube reconstruction with cervical anastomosis for an esophageal carcinoma, the patient suffered from colicky pain in the right abdomen. The diagnostics showed an ileocecal invagination up to the right flexure of the colon. The invagination was based on a leiomyoma of the terminal ileum. Because of necrosis of the mucous membrane, an ileocecal resection with ileoascendostomy could not be avoided. We discuss this case on the basis of the existing literature.
    Der Chirurg 10/2003; 74(9):856-9. · 0.52 Impact Factor
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    ABSTRACT: Wir berichten ber den Fall einer postoperativen ileozkalen Invagination eines 63-jhrigen mnnlichen Patienten als Ursache eines mechanischen Ileus nach sophagus- und Magenteilresektion, Magenschlauchbildung und -transposition mit kollarer Anastomose bei sophaguskarzinom. Am 46. postoperativen Tag klagte der Patient ber pltzlich auftretende rechtsseitige kolikartige Bauchschmerzen. Die Diagnostik ergab den Befund eines mechanischen Dnndarmileus bei ileozkaler Invagination bis zur rechten Kolonflexur. Urschlich zeigte sich ein vom terminalen Ileum ausgehendes benignes Leiomyom. Bei bereits fortgeschrittener Schleimhautnekrose konnte eine Ileozkalresektion mit Ileoaszendostomie nicht umgangen werden. Dieser Fall wird anhand der aktuellen Literatur diskutiert.We report a case of postoperative ileocecal invagination in a 63-year-old male. Forty-six days after esophageal resection and gastric tube reconstruction with cervical anastomosis for an esophageal carcinoma, the patient suffered from colicky pain in the right abdomen. The diagnostics showed an ileocecal invagination up to the right flexure of the colon. The invagination was based on a leiomyoma of the terminal ileum. Because of necrosis of the mucous membrane, an ileocecal resection with ileoascendostomy could not be avoided. We discuss this case on the basis of the existing literature.
    Der Chirurg 08/2003; 74(9):856-859. · 0.52 Impact Factor
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    ABSTRACT: There are several differential diagnoses for acute abdominal discomfort with pain referred to the right lower quadrant region. The objective of this report is to outline our experience with diverticulitis of the caecum, which is a rare condition that is particularly difficult to diagnose correctly pre-operatively. A retrospective analysis of acute diverticulitis of the caecum was performed over the period from January 1992 to December 2000 within the Surgical Department of the RWTH Aachen, Germany. The progress of each patient was assessed by interviewing the patient and by telephone contact with the patient's general practitioner. Seven patients with isolated infective diverticulitis of the caecum were encountered in the course of this study. In five of these cases, the pre-operative diagnosis was either unclear or incorrect. Four patients underwent surgery for suspected appendicitis. In one patient, the diverticulitis was diagnosed during laparoscopic surgery undertaken for presumed adnexal disease. Intestinal continuity was restored in all cases. The postoperative course was uneventful. Right-sided caecal diverticulitis is rare in comparison to diverticulitis of the sigmoid or descending colon. Nevertheless, it should be actively considered in the differential diagnosis of patients with acute tenderness in the right lower abdominal region.
    Colorectal Disease 06/2003; 5(3):241-5. · 2.08 Impact Factor
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    ABSTRACT: There are few objective studies in the surgical literature on the strength of an inguinal hernia repair during the immediate postoperative period. To provide the relevant advice and recommendations on physical activities during the period of convalescence, a study on the strength of the Shouldice repair was carried out. Twenty-eight Shouldice repairs were performed on 17 fresh human cadavers (11 male, 17 female, mean age 79.9+/-6.2 years). Following the excision of the transversalis fascia, the breaking strength and tissue elasticity were measured using an automated test device. All tissue ruptures occurred outside the limits of the Shouldice repair. Mean breaking strength was 53.9+/-20.1 N, showing no significant differences between males and females. The measured overall elasticity of tissue samples was 4.6+/-2.3 N/cm. Again there was no marked difference between genders. However, breaking strength and elasticity were found to be significantly affected by age. The Shouldice repair demonstrated a higher tensile strength when compared to the surrounding tissue. Strength after a Shouldice repair of the floor of the inguinal canal was found to be several times higher than could be attained under physiologic conditions. Therefore, an early postoperative return to normal activity can be recommended.
    Hernia 04/2003; 7(1):17-20. · 1.69 Impact Factor
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    ABSTRACT: A total of 140 patients presenting with umbilical hernia underwent Spitzy's operation and were included in a retrospective study to analyse the recurrence rate. The patients received a questionnaire and were invited for a physical examination including ultrasound. Participation included 108 patients (follow-up 77%). A total of seven patients (6.5%) developed postoperative wound infections. Prolonged postoperative impairment was mentioned by nine patients (8.3%). After a mean period of 16 days, the patients were able to continue their occupation, and after 27 days, they could manage their usual physical activity. The recurrence rate was 13.0%. The risk for a recurrence correlated with the relative bodyweight. In the group with a body-mass-index (BMI) of less than 30, the recurrence rate was 8.1 %, whereas 31.8% of the patients with a BMI of more than 30 developed a recurrent hernia. The size of the hernial orifice also had an influence on the postoperative result. In patients with a hernial gap smaller than 1 cm the recurrence rate was 6.3%, with hernia orifices from 1 to 2 cm the rate was 4.1%, from 2 to 3 cm 14.3%, from 3 to 4 cm 25.0% and in patients with hernial gaps greater than 4 cm the rate of recurrences was 54.5%. Considering these results,we recommend the use of alloplastic material for umbilical hernia repair for patients with a BMI greater than 30.0 and hernia orifice larger than 3 cm. The decision for use of a mesh in hernial gaps from 2 to 3 cm should depend on individual factors.
    Der Chirurg 02/2003; 74(1):50-4. · 0.52 Impact Factor
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    ABSTRACT: Tumors of the retrorectal space are rare entities. The case report of a retrorectal tailgut cyst serves to illustrate the clinical and diagnostic findings, differential diagnosis, and therapy of retrorectal tumors. Tumors in this area can be identified by palpation. The subsequent investigations include ultrasound, endosonography, endoscopy, and by choice computed tomography or magnetic resonance imaging. Usually tailgut cysts are characterized as cystic tumors, well delineated with multicystic formation. The diagnosis has to differentiate between carcinomas of the colorectum, hamartomas, lymphomas, teratomas, chordomas, abscess formation, dermoid cysts, epidermoid cysts, and enteral cysts. An elevated level of CEA may point to malignancy. Complete surgical resection is the therapy of choice.
    Der Chirurg 12/2002; 73(11):1123-6. · 0.52 Impact Factor
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    ABSTRACT: Retrorektale Raumforderungen sind in der chirurgischen Praxis seltene Einzelfälle. An der Fallbeschreibung einer Schwanzdarmzyste (“retrorectal tailgut cyst”) werden Klinik, Diagnostik, Differenzialdiagnostik und Therapie retrorektal gelegener Tumoren dargestellt. Meist lassen sich die Tumoren palpatorisch identifizieren, die folgende Diagnostik umfasst neben der Sonographie die Endosonographie, Endoskopie und fakultativ die radiologische Bildgebung mittels CT oder MRT. Schwanzdarmzysten stellen sich in der Regel als zystische Raumforderung mit glatter Begrenzung und multizystischer Ausprägung dar. Die Differenzialdiagnose umfasst kolorektale Karzinome, Hamartome, Lymphome, Teratome, Chordome, Abszesse, Dermoidzysten, Epidermoidzysten und enterale Zysten. Ein erhöhter CEA-Tumormarker kann auf eine maligne Entartung weisen, die nach Literatur in 10% aller Fälle auftritt. Therapie der Wahl ist die chirurgische Entfernung in toto. Tumors of the retrorectal space are rare entities. The case report of a retrorectal tailgut cyst serves to illustrate the clinical and diagnostic findings, differential diagnosis, and therapy of retrorectal tumors. Tumors in this area can be identified by palpation. The subsequent investigations include ultrasound, endosonography, endoscopy, and by choice computed tomography or magnetic resonance imaging. Usually tailgut cysts are characterized as cystic tumors, well delineated with multicystic formation. The diagnosis has to differentiate between carcinomas of the colorectum, hamartomas, lymphomas, teratomas, chordomas, abscess formation, dermoid cysts, epidermoid cysts, and enteral cysts. An elevated level of CEA may point to malignancy. Complete surgical resection is the therapy of choice.
    Der Chirurg 10/2002; 73(11):1123-1126. · 0.52 Impact Factor
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    ABSTRACT: Repair of a groin hernia is strongly influenced by prosthetic mesh implantation carried out in nearly 50 % of all operations. Recurrency rates, however, did not decrease by this policy. Many different materials are available. Due to bioinstability on the long-term and elevated infection rates PTFE is not suitable for inguinal hernia repair. Polyester also provides no long-term stability and induces a chronic foreign body reaction. Polypropylene initially leads to an acute inflammatory reaction and often ends in fibrosis. Both reactions are related to the weight of the used mesh. All materials may lead to specific complications. These include seroma formation, infection, migration of the prosthesis with arrosion of organs, damage of the vas deferens, development of recurrency by shrinkage of the fibers around the mesh, formation of adhesions in the preperitoneal position, and chronic inguinal pain. Therefore, meshes should be used only after individual estimation of risks and benefit. This includes the hernia classification, the number of previous operations and the possibility of a defect in collagen metabolism. The unknown long-term risks for the patient may be taken only in strong indications.
    Zentralblatt für Chirurgie 08/2002; 127(7):573-7. · 0.69 Impact Factor
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    ABSTRACT: Malignant tumors associated with hernial sacs are rare entities. A review of literature offers only small groups of patients. The high incidence of inguinal hernia repair operations demands recognition of this morbidity. It should be suspected in cases of tight tissue in the hernial sac in differentiation to the unreduced inguinal and femoral hernia. Therapy of choice must be a resection in toto (R0), incomplete resection causes inguinal spreading or recurrence of the tumor. The exact evaluation of the surroundings should follow. There is no other standardized therapy besides operation. A case of leiomyosarcoma in inguinal hernia will present the entity of neoplastic disease in hernial sac.
    Der Chirurg 04/2002; 73(3):283-6. · 0.52 Impact Factor
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    ABSTRACT: Zusammenfassung Maligne tumoröse Veränderungen des Bruchsacks beim Leistenbruch sind seltene Einzelfälle. Eine Durchsicht der Literatur bietet hier keine großen Fallgruppen. Die Häufigkeit der Leistenbruchoperation verlangt jedoch auch die Kenntnis dieses Krankheitsbildes, das bei einer gewebsdichten Raumforderung in der Leistenregion differenzialdiagnostisch zum irreponiblen Leisten- oder Schenkelbruch in Erwägung gezogen werden muss. Die operative Therapie der Wahl ist immer einer Resektion in toto (R0), die inkomplette Resektion kann neben dem Rezidiv die inguinale Ausbreitung des Tumors zur Folge haben. Anschließen sollten sich eine differenzierte Umgebungsdiagnostik sowie ggf. weitere operative Maßnahmen. Standardisierte adjuvante Verfahren der Chemotherapie oder der Bestrahlung existieren nicht. Erläutert wird das Krankheitsbild an dem Fallbericht eines Leiomyosarkoms des Bruchsacks bei einer inguinalen Leistenhernie.
    Der Chirurg 01/2002; 73(3):283-286. · 0.52 Impact Factor
  • Zentralblatt Fur Chirurgie - ZBL CHIR. 01/2002; 127(7):573-577.

Publication Stats

250 Citations
39.50 Total Impact Points

Institutions

  • 2009
    • Evangelisches Krankenhaus Hamm
      Hamm, North Rhine-Westphalia, Germany
  • 1996–2006
    • RWTH Aachen University
      • • Klinik für Allgemein-, Viszeral- und Transplantationschirurgie
      • • Neurochirurgische Klinik
      Aachen, North Rhine-Westphalia, Germany
  • 1991–2001
    • University Hospital RWTH Aachen
      • Department of Neurology
      Aachen, North Rhine-Westphalia, Germany
  • 1997–1999
    • Krankenhaus Porz am Rhein
      Porz am Rhein, North Rhine-Westphalia, Germany