Redo-Posterior Neurectomy or Conservative Treatment for Recurrent Pain After Posterior Neurectomy in Anterior Cutaneous Nerve Entrapment Syndrome – A Case Comparison Analysis

TL;DR

This study compares redo-posterior neurectomy and conservative treatments for ACNES patients with recurring pain after a prior successful surgery.

Contribution

The study provides evidence that redo-posterior neurectomy is more effective than conservative treatment for recurrent ACNES pain.

Findings

Short-term surgical success rate was 95% after redo-posterior neurectomy.

Long-term pain reduction was significantly better with surgery (85%) compared to conservative treatment (41%).

Patient Global Impression of Change was also better with surgery (70%) than with conservative treatment (41%).

Abstract

To provide insight into treatment outcomes of a redo-posterior neurectomy compared to conservative treatments in ACNES patients with recurrent pain after a previous successful posterior neurectomy.

Most patients with chronic abdominal pain due to anterior cutaneous nerve entrapment syndrome (ACNES) benefit from a step-up treatment regimen including abdominal wall injections, pulsed radiofrequency, or surgery (an anterior or posterior neurectomy). However, some 20% of patients who underwent an initially successful posterior neurectomy develop recurrent pain. To date, studies regarding treatment options and outcomes of these patients are scarce.

Eligible patients who received treatment in our center of expertise between January 2012 and February 2023 were analyzed using a questionnaire. Success was defined as a minimal 50% pain reduction for at least 3 months postoperatively using pain scores and Patient Global Impression of Change (PGIC).

Of 57 eligible patients, 37 (76% female, mean age 39 years) completed the questionnaire (65% response rate). Twenty had undergone a redo-posterior neurectomy whereas the remaining 17 patients continued conservative measures. Short-term surgical success rate was 95%. In the long-term (median 40 months), surgical treatment outcome was more successful compared to a conservative treatment regarding pain reduction (85% vs. 41%; p = 0.008) and PGIC (70% vs. 41%; p = 0.018).

Based on the current study, redo-posterior neurectomy may be considered a beneficial option for ACNES patients with recurrent pain after an initially successful posterior neurectomy.

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