C Peiper

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

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Publications (43)35.11 Total impact

  • C. Peiper · K. Junge · A. Oettinger · M. Binnebösel
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    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;
  • Polish Journal of Surgery 01/2007; 79(2):63-69. DOI:10.2478/v10035-007-0011-0
  • 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 implantation of a non-absorbable polypropylene mesh during hernia repair causes chronic foreign body reaction involving the surrounding tissue. In case of inguinal hernia repair using mesh techniques, the spermatic cord is potentially affected by this chronic inflammatory tissue remodeling. This effect has been investigated using standardized animal models (pig and rabbit). Fifteen adult male pigs underwent transinguinal preperitoneal implantation of a polypropylene mesh. The contralateral side with a Shouldice repair served as control. After 7, 14, 21, 28, and 35 days, three animals were sacrificed. The spermatic cords were resected and analyzed histologically. In a second experiment Lichtenstein repair using the same polypropylene mesh and Shouldice repair on the contralateral side was done in eight chinchilla rabbits. Three animals served as controls. Three months after operation, the analysis included testicular size, testicular temperature, and testicular and spermatic cord perfusion. We added histological evaluation of the foreign body reaction and the spermatogenesis using the Johnsen score. In the pig, we observed a certain foreign body reaction with diffuse infiltrating inflammatory cells after mesh implantation. Venous thrombosis of the spermatic veins occurred in five of 15 cases. One animal presented focal fibrinoid necrosis of the deferent duct wall. The side of Shouldice repair showed only minor postoperative changes. In the rabbit, we also observed a typical foreign body reaction at the interface between mesh and surrounding tissue, which was not detectable after Shouldice repair. The mesh repair led to a decrease of arterial perfusion, testicular temperature, and the rate of seminiferus tubules with regular spermatogenesis classified as Johnsen 10 (Lichtenstein: 48.1%, Shouldice: 63.8%, controls: 65.8%). Testicular volume increased about 10% after each operation. The implantation of a polypropylene mesh in the inguinal region induces major response of the structures of the spermatic cord. This may have an influence also on spermatogenesis. Due to this a strict indication for implantation of a prosthetic mesh during inguinal hernia repair is recommended.
    Hernia 04/2006; 10(1):7-12. DOI:10.1007/s10029-005-0055-1 · 2.09 Impact Factor
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    ABSTRACT: The permanent implantation of a polypropylene mesh during inguinal hernia repair causes chronic inflammatory changes in the surrounding tissue. We investigated the effect of this foreign body reaction on the structures of the spermatic cord in the rabbit. Eight Chinchilla rabbits underwent unilateral inguinal hernia repair by the Lichtenstein technique using Marlex (n = 4) or Ultrapro (n = 4) mesh. The contralateral side was operated upon using the Shouldice repair. Three animals served as controls. Three months after operation we analyzed testicular size, testicular temperature, and arterial perfusion by excitation light of a 780-nm laser after injection of 0.5 mg/kg indocyanin green. Histological evaluation included spermatogenesis (Johnsen score) and foreign-body reaction. Testicular volume increased about 10% after each operation. The decrease of arterial perfusion and testicular temperature was more significant after mesh repair than following Shouldice operation. After mesh implantation we found fewer seminiferous tubules classified as Johnsen 10 (Marlex: 51.3%, Ultrapro: 45.0%) than after Shouldice repair (63.8%) or in the controls (65.8%). The spermatic cord showed a typical foreign-body reaction at the interface between mesh and surrounding tissue, which was not detectable after Shouldice repair. Preserved cremasteric muscle fibers protected the structures of the spermatic cord. The inflammatory foreign-body reaction of the surrounding tissue induced by the inguinal prosthetic mesh includes the structures of the spermatic cord. This may have an influence also on spermatogenesis. Therefore, we recommend strict indications for implantation of a prosthetic mesh during inguinal hernia repair.
    Journal of Investigative Surgery 09/2005; 18(5):273-8. DOI:10.1080/08941930500249027 · 1.19 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. DOI:10.1007/s10029-004-0292-8 · 2.09 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: Zusammenfassung
    Der Chirurg 05/2005; 76(5):487-492. DOI:10.1007/s00104-004-0977-7 · 0.52 Impact Factor
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    ABSTRACT: During endotoxemia, the systemic inflammatory response often leads to severe pulmonary damages. Destruction of endothelial cells, interstitial edema, and interstitial alveolitis depress pulmonary circulation and raise extravascular lung water and intrapulmonary shunt. As protective effects of zinc are described in vitro as well as in vivo, this study investigates its impact on septic porcine pulmonary endothelial monolayers as well as on the pulmonary function of endotoxemic pigs. Cell culture: Endothelial cells were incubated with ascending doses of zinc and pooled with septic plasma. Cellular damage, metabolism, and proliferation were measured by vital stain, XTT-assay, and BrDU-ELISA. HSP70 was visualized by immunohistochemistry. Animal study: We used an established porcine model. Twenty-four hours before endotoxemia (intravenous infusion of 1.0 microg/kg Escherichia coli endotoxin WO111:B4), each animal received an intravenous pretreatment. Group I (n = 3): saline pretreatment, group II (n = 5): zinc pretreatment (5 mg/kg elementary zinc). Monitoring included blood gas analysis and the thermal dye dilution technique. In vitro, zinc leads to significantly altered rates of viable cells, metabolism, and proliferation with the strongest cell-protective effect at moderate concentrations of 1 microg/ml Zn2+. This correlates with a qualitatively increased expression of HSP70. In vivo, the zinc pretreatment before LPS-induced endotoxemia grossly improves all measured hemodynamic and pulmonary parameters. Zinc pretreatment of endotoxemia decreases cellular damages in vitro and improved pulmonary function in vivo. This could be mediated by the heat shock response. Further studies, particularly concerning the dose-effect relationship and the underlying mode of action, are mandatory.
    Journal of Surgical Research 03/2005; 123(2):251-6. DOI:10.1016/j.jss.2004.08.024 · 2.12 Impact Factor
  • C Peiper · K Junge · A Prescher · M Stumpf · V Schumpelick
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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. DOI:10.1007/s10029-004-0254-1 · 2.09 Impact Factor
  • Viszeralchirurgie 01/2005; 40(5):325-330. DOI:10.1055/s-2005-836909 · 0.06 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. DOI:10.1007/s10029-002-0103-z · 2.09 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. DOI:10.1007/s00104-002-0536-z · 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. DOI:10.1007/s00104-002-0515-4 · 0.52 Impact Factor
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    ABSTRACT: To record intraoperative tension during Shouldice hernioplasty and correlate it with postoperative course and long-term outcome. Prospective clinical trial. University clinic, Germany. 20 male patients undergoing elective primary inguinal hernia repair by Shouldice technique. Measurement of intraoperative tension during hernioplasty (low 0-2.0 N, moderate 2.1-4.0 N, high > 4.1 N). Main outcome measures: Postoperative pain measured by visual analogue scale (VAS) at rest and activity, pain-related change of ventilatory measurements (8, 24 and 48 hours after intervention), postoperative complications, length of stay in hospital, and recurrence rate at mean 46.7 (range 43-54) months after operation. Data are given as mean (SD). The results for 18 patients were analysed, 2 being lost to follow up. Mean pain score was 17.5 (15.6), 14.8 (15.6) and 12.3 (14.9) at rest 8 hours, 24 hours and 48 hours after operation, during activity 42.0 (16.5), 36.4 (18.5) and 33.7 (19.1) respectively. Most depression of ventilatory measurements was found 8 hours after operation (vital capacity 88.4 (12.5)%. peak flow 81.3 (17.2)%) compared with preoperative values. Complications comprised one seroma, one subcutaneous wound infection, and 3 haematomas. Mean length of stay in hospital was 4.3 (range 2-7) days. At follow up, no recurrences were found. No correlation with intraoperatively-induced tension was found. Postoperative pain and recurrences depend on many factors, but induced intraoperative tension can be excluded. The reported advantages of tension-free procedures are not based on the avoidance of tension. The Shouldice repair can therefore continued to be used as a routine technique in uncomplicated primary inguinal hernia repair.
    The European Journal of Surgery 09/2002; 168(6):329-33. DOI:10.1080/11024150260284824
  • C J Krones · K Junge · J Conze · C Peiper · V Schumpelick
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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. DOI:10.1007/s00104-002-0426-4 · 0.52 Impact Factor
  • Christian Peiper · J Nowack · K Ktenidis · S Hopstein · G Keresztury · S Horsch
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    ABSTRACT: The symptomatic patient showing a string sign or ulcerative stenosis of the internal carotid artery (ICA) is subject to a high risk of arterial thrombosis or persisting intracranial embolization during the waiting period before operative revascularization. During one year 186 operative revascularization procedures of the ICA were performed on the symptomatic patient. 26 of them fulfilled the prophylactic urgency criteria: symptoms of the cerebrovascular insufficiency and a string sign or ulcerative stenosis of the ICA with ulceration greater than 2 mm in depth. These results were compared to the control group of the 157 procedures under elective circumstances. Mean clamping time of the urgency and the elective patients were 23.8 min vs. 24.5 min and operation time 50.1 min vs. 54.3 min. None of our urgency patients presented new neurological defects in the postoperative phase, while this occurred in 3.8% in the elective group. Mortality rate in the elective group was 2.7% and 0% in the urgency group. Furthermore, there were fewer local complications in the urgency group. The urgent indication for the desobliteration of the ICA showing a symptomatic string sign or ulcerative stenosis can be recommended. Early thrombosis or neurological defects during the waiting period may be prevented without increasing complication rates.
    VASA.: Zeitschrift für Gefässkrankheiten. Journal for vascular diseases 12/2001; 30(4):247-51. DOI:10.1024/0301-1526.30.4.247 · 1.21 Impact Factor
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    ABSTRACT: Tension of the abdominal wall in the inguinal region induced by Shouldice repair of an inguinal hernia is said to be responsible for elevated postoperative pain levels. In 20 patients we recorded the inguinal tensile strength during closure of the hernial gap using a wound retractor equipped with strain gauges. Postoperative pain levels were scaled using a visual analogous score, and correlated with the tensile strength of the inguinal abdominal wall together with peak flow and forced expiratory volume in 1 s (FEV1) 8, 24, and 48 h after the time of operation. Shouldice repair caused an average increase in inguinal tensile strength of 2.9 +/- 0.58 N (mean +/- SEM). The pain level expressed by active patients was twice the value obtained from resting patients (41.55 +/- 6.3% vs 20.81 +/- 7.1% 8 h after operation), but decreased slightly later on. Peak flow during forced expiration was depressed to about 80% of the control values, whereas the 1-s volume during forced expiration decreased only to 95% of the control value. We excluded any correlation between the recorded individual inguinal tensile strength or the changes in distance between the lateral edge of the rectus sheath and the base of the inguinal ligament and the postoperative pain level. We failed to see any evidence for the hypothesis that higher inguinal tensile strength induced by Shouldice repair leads to an elevated level of postoperative pain. If there is any effect, it may be masked by other factors with a stronger influence.
    Hernia 10/2001; 5(3):129-34. DOI:10.1007/s100290100025 · 2.09 Impact Factor

Publication Stats

298 Citations
35.11 Total Impact Points

Institutions

  • 2009
    • Evangelisches Krankenhaus Hamm
      Hamm, North Rhine-Westphalia, Germany
  • 1996–2005
    • RWTH Aachen University
      • • Institute of Pathology
      • • Department of Surgery
      Aachen, North Rhine-Westphalia, Germany
  • 1997
    • Krankenhaus Porz am Rhein
      Porz am Rhein, North Rhine-Westphalia, Germany
  • 1995
    • University Hospital RWTH Aachen
      Aachen, North Rhine-Westphalia, Germany