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. 2024 Oct 3:3:13508.
doi: 10.3389/jaws.2024.13508. eCollection 2024.

Long-Term Efficacy of Posterior Neurectomy in Anterior Cutaneous Nerve Entrapment Syndrome

Tom Ten Have  1   2   3 , Monica L Y E Jacobs  1   2   3 , Marc R M Scheltinga  1   2 , Willem A R Zwaans  1   2   3 , Rudi M H Roumen  1   2
Affiliations

Long-Term Efficacy of Posterior Neurectomy in Anterior Cutaneous Nerve Entrapment Syndrome

Tom Ten Have et al. J Abdom Wall Surg. .

Abstract

Objective: To analyze long-term treatment outcomes of a posterior neurectomy in a large cohort of patients with anterior cutaneous nerve entrapment syndrome (ACNES).

Summary background data: The current step-up treatment approach for ACNES involves abdominal wall tender point injections, pulsed radiofrequency, and neurectomy. If an anterior neurectomy fails or pain reoccurs, a posterior neurectomy is considered as a final surgical option. Data on posterior neurectomy treatment outcomes are scarce.

Methods: ACNES patients who underwent a unilateral posterior neurectomy between 2012 and 2022 in a single institution completed a questionnaire regarding their current pain status. Primary outcomes were short- and long-term treatment success, defined as ≥50% pain relief. Patients were stratified whether the operative indication was recurrent pain (>3 months) after an initially successful anterior neurectomy or ongoing pain after an anterior neurectomy.

Results: Data from 260 of 379 patients (77% female, mean age 42 years) were analyzed (68.6% response rate). Sensitivity analysis found that short-term outcomes were similar between responders and non-responders. The recurrent pain group demonstrated significantly better treatment outcomes compared to the ongoing pain group, both in the short-term (7 weeks; treatment success 79.2% vs. 53.2%, p < 0.001) and long-term (58 months; treatment success 61.1% vs. 42.0%, p = 0.001). Sixteen (minor) complications (6.2%) were reported, resulting in three surgical re-interventions (1.2%).

Conclusion: A posterior neurectomy is long-term beneficial in approximately half of patients although treatment success is better for recurrent pain than ongoing pain. These findings aid in optimizing preoperative patient counseling.

Keywords: acnes; chronic abdominal wall pain; long term outcomes; neurectomy; surgical outcomes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Re-incision of the previous neurectomy scar.
FIGURE 2
FIGURE 2
The anterior rectus sheath is exposed after dissection through subcutaneous tissue. Check for and coagulate any remaining penetrating neurovascular bundles.
FIGURE 3
FIGURE 3
(A) Transverse incision of the anterior rectus sheath, which is held up by the tweezers, to expose the rectus abdominis muscle. (B) Longitudinal incision of the anterior rectus sheath.
FIGURE 4
FIGURE 4
The rectus abdominis muscle is retracted medially to visualize the posterior rectus sheath.
FIGURE 5
FIGURE 5
(A,B) Identification of an obliquely running nerve (arrow) at the level of the posterior rectus sheath.
FIGURE 6
FIGURE 6
Proximal cauterization and resection of the nerve under traction. Normally at least two nerve bundles are found and excised.
FIGURE 7
FIGURE 7
Closure of the wound in layers; (A,B) anterior fascia, (C) subcutaneous tissue, (D) skin and infiltration with a long acting local anesthetic.
FIGURE 8
FIGURE 8
Study flowchart.
FIGURE 9
FIGURE 9
Treatment outcomes of posterior neurectomy for both ACNES groups (A) after 7 weeks short-term follow-up (p < 0.001) (B) after 58 months long-term follow-up (p = 0.001).
FIGURE 10
FIGURE 10
Patients global impression of change (PGIC) following a posterior neurectomy for ACNES at 58 months follow-up (p < 0.001).
See this image and copyright information in PMC

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