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

Sep 29, 2026

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Redo-posterior neurectomy is evaluated as a treatment option for anterior cutaneous nerve entrapment syndrome (ACNES) patients who develop recurrent pain after an initially successful posterior neurectomy. A cross-sectional cohort of eligible patients treated between January 2012 and February 2023 was analyzed using questionnaires; success required at least 50% pain reduction for a minimum of three months and was assessed with pain scores and PGIC. Surgical management showed higher long-term success than conservative treatment in pain reduction and PGIC.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

INTRODUCTION

MATERIALS AND METHODS

RESULTS

CONCLUSION

*Correspondence Tom ten Have, [Tom.ten.Have@mmc.nl](Tom.ten.Have@mmc.nl) Received: 28 April 2025 Revised: 15 October 2025 Accepted: 05 December 2025 Published: 22 December 2025 Citation: ten Have T, ScheltingaMRM, Bekers E, Zwaans WAR and Roumen RMH (2025) Redo-Posterior Neurectomy or Conservative Treatment for Recurrent Pain After Posterior Neurectomy in Anterior Cutaneous Nerve Entrapment Syndrome – A Case Comparison Analysis. J. Abdom. Wall Surg. 4:14828. doi: 10.3389/jaws.2025.14828 Redo-Posterior Neurectomy or Conservative Treatment for Recurrent Pain After Posterior Neurectomy in Anterior Cutaneous Nerve Entrapment Syndrome – A Case Comparison Analysis Tom ten Have 1,2,3 *, Marc R. M. Scheltinga 1,2, Elise Bekers 4, Willem A. R. Zwaans 1,2,3 and Rudi M. H. Roumen 1,2 1Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands, 2SolviMáx, Centre of Expertise for Complex Groin and Abdominal Wall Pathology, Máxima Medical Centre, Eindhoven, Netherlands, 3NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands, 4Department of Pathology, Clinical Diagnostics PAMM, Eindhoven, Netherlands 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. Keywords: abdominal pain, chronic abdominal wall pain, acnes, neurectomy, surgery Journal of Abdominal Wall Surgery | Published by Frontiers 1 December 2025 | Volume 4 | Article 14828 INTRODUCTION The anterior cutaneous nerve entrapment syndrome (ACNES) is a common cause of chronic abdominal wall pain [1, 2]. Although its management is challenging, studies from our center of expertise reported an almost 90% success rate using a strict treatment algorithm [3, 4]. For instance, approximately 45% of patients achieve sufﬁcient pain relief following minimally invasive tender point injections or pulsed radiofrequency (PRF) treatment [3–7] . Unresponsive individuals are usually counselled for a neurectomy of end branches of the intercostal nerves in the anterior abdominal wall [2, 6, 8] . Two surgical options are included in the treatment algorithm. At ﬁrst, an anterior neurectomy is proposed. If unsuccessful, a posterior neurectomy is suggested. Long-term success rates are 60% and 50%, respectively [3, 9, 10] . However, outcome after the posterior neurectomy is dependent on earlier surgical su

FAQs

What patient group is studied in this article?

ACNES patients who experienced recurrent pain after a previous posterior neurectomy that initially provided sufficient relief.

How is treatment success defined?

Success required a minimal 50% pain reduction for at least 3 months postoperatively, evaluated using pain scores and Patient Global Impression of Change (PGIC).

How do redo-posterior neurectomy outcomes compare with conservative treatment?

Long-term surgical outcomes were more successful than conservative care regarding pain reduction (85% vs. 41%) and PGIC (70% vs. 41%).

Sep 29, 2026

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