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World Journal of Surgery

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01-12-2014 | Original Scientific Report

Surgical Options after a Failed Neurectomy in Anterior Cutaneous Nerve Entrapment Syndrome

Authors: T. van Assen, O. B. Boelens, P. V. van Eerten, M. R. Scheltinga, R. M. Roumen

Published in: World Journal of Surgery | Issue 12/2014

Abstract

Background

Injection treatment followed by an anterior neurectomy in patients insufficiently responding to an injection regimen is successful long term in three-quarters of patients with anterior cutaneous nerve entrapment syndrome (ACNES). The efficacy of secondary surgery, including re-exploration or a posterior neurectomy in patients reporting recurrent pain after initially successful surgery or following an immediately failed anterior neurectomy is unknown.

Methods

A database of ACNES patients receiving surgery between 2004 and 2012 in the SolviMáx institution was analysed. Adult patients with residual pain after an anterior neurectomy (failures) or with recurrent pain after initially successful surgery (recurrences) were selected. Following a re-exploration or a posterior neurectomy, pain was scored using a pain intensity numeric rating scale (PI-NRS 0–10) and a six-point verbal category rating scale (VRS). Success was defined as a ≥50 % PI-NRS reduction and/or ≥2 point VRS reduction.

Results

ACNES patients undergoing an anterior neurectomy (n = 181) were analysed during the 8-year study period. At follow-up, 51 patients reported unacceptable pain levels following an anterior neurectomy, whereas 20 developed recurrent abdominal wall pain. Of these 71 unsuccessful patients, 41 underwent secondary surgery, including a re-exploration (n = 10), or a posterior neurectomy (n = 31). After a 25-month median follow-up, secondary surgical treatment regimens proved successful in 66 % (27/41). Patients with recurrent pain did better (14/15) than patients who were immediate failures after the anterior neurectomy (13/26, p = 0.01).

Conclusions

Secondary surgery including re-explorations and posterior neurectomies are successful in two-thirds of ACNES patients with persistent pain or recurrence of pain after an anterior neurectomy.

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Title: Surgical Options after a Failed Neurectomy in Anterior Cutaneous Nerve Entrapment Syndrome
Authors: T. van Assen
O. B. Boelens
P. V. van Eerten
M. R. Scheltinga
R. M. Roumen
Publication date: 01-12-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 12/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-014-2737-2

At a glance: The STEP trials

Springer Medicine

Surgical Options after a Failed Neurectomy in Anterior Cutaneous Nerve Entrapment Syndrome

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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