title: Surgical options after a failed neurectomy in anterior cutaneous nerve entrapment syndrome.
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.
authors.affiliation: Department of Surgery, Máxima Medical Center, de Run 4600, P.O. Box 7777, 5500 MB, Eindhoven, Veldhoven, The Netherlands, tijmenvanassen@gmail.com.
authors.forename: T
authors.initials: T
authors.lastname: van Assen
authors.forename: O B
authors.initials: OB
authors.lastname: Boelens
authors.forename: P V
authors.initials: PV
authors.lastname: van Eerten
authors.forename: M R
authors.initials: MR
authors.lastname: Scheltinga
authors.forename: R M
authors.initials: RM
authors.lastname: Roumen
mesh_terms: D034861:Abdominal Wall; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000150:complications / Q000601:surgery* / Q000628:therapy; D010146:Pain / Q000209:etiology / Q000601:surgery*; D010147:Pain Measurement; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult