Anterior neurectomy in children with a recalcitrant anterior cutaneous nerve entrapment syndrome is safe and successful.
BACKGROUND
Anterior cutaneous nerve entrapment syndrome (ACNES) is a relatively unknown cause of severe neuralgic abdominal pain. Treatment includes medication, local nerve blocks or, if unresponsive, a neurectomy of nerve endings. In children, the outcome of neurectomy for ACNES is scantly described in retrospective studies. The objective of this first prospective study was to investigate the safety and short term success rate of anterior neurectomy in a large pediatric population with ACNES.


METHODS
All children <18years with failed non-surgical treatments for ACNES who underwent an anterior neurectomy in a pediatric surgical referral center between March 2012 and June 2015 were prospectively followed. Patients with previous ACNES surgery were excluded. Primary outcome measures were pain relief and adverse events.


RESULTS
60 children were included (80% female, mean age 15years±2 SD). 75% had right lower abdominal pain. At first follow-up, 47 children were free of pain (78% success rate). Complications other than an occasional local hematoma were not reported. Outcome was not related to demographics, preoperative pain intensity, pain duration or localization.


CONCLUSIONS
Anterior neurectomy is safe and successful in most children with abdominal pain failing a conservative treatment for ACNES.


METHODS
Treatment study.


METHODS
IV.
Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands. Electronic address: m.siawash@gmail.com.
Murid
M
Siawash
Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
Robbert
R
Maatman
Department of Pediatrics, Máxima Medical Center, Veldhoven, The Netherlands.
Walther
W
Tjon A Ten
Department of Pediatric Surgery, Emma Children's Hospital AMC & VU University medical center, Amsterdam, The Netherlands.
Ernst
E
van Heurn
Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
Rudi
R
Roumen
Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands.
Marc
M
Scheltinga
D000009:Abdominal Muscles / Q000294:innervation*; D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery*; D000293:Adolescent; D005260:Female; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods*; D009408:Nerve Compression Syndromes / Q000150:complications / Q000601:surgery*; D019635:Neurosurgical Procedures; D010147:Pain Measurement; D011446:Prospective Studies; D016896:Treatment Outcome
ACNES; Abdominal wall; Child; Neurectomy; Pain; Surgery