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

Objective 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.Summary Background Data 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.Methods 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).Results 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).Conclusion 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.