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.