Surgery for Anterior Cutaneous Nerve Entrapment Syndrome: a
double blind randomised placebo controlled trial
OB Boelens MDa, MR Scheltinga MDa, S Houtermanb, RM Roumen MDa
Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) is hardly considered in the
differential diagnosis of chronic abdominal pain. However, for many of these patients a
permanent solution can be achieved by simple measures. Purpose of the present trial was to
clarify the role of a neurectomy on refractory patients following conservatively treated
ACNES. We hypothesized that pain attenuation following neurectomy is the result of
resection of the entrapped nerve at the level of the ventral Rectus fascia.
Patients >18 years meeting the inclusion criteria were randomised to receive a neurectomy
or sham procedure. Both patient and principal investigator were blinded to the nature of the
procedure. Pain was recorded using a Visual Analogue Scale (VAS: 1-100 mm) and a Verbal
Rating Scale (VRS: 0 = no pain, 5 = severe pain) during physical examination prior to and 6
weeks after surgery. A reduction of at least 50% on VAS and/or 2 points on VRS was
considered a ‘successful response’.
Between August 2008 and December 2010 some 44 patients were randomised (5 males and
39 females, median age 42, both arms n=22). In the sham group 3 patients reported a
successful response compared to 15 in the neurectomy group (p = 0·001).
Conclusions: Pain reduction following neurectomy in these ACNES patients is based on
resection of the entrapped nerve at the ventral Rectus fascia. This simple procedure is
successful in a substantial number of refractory patients following conservative measures.