Anterior neurectomy in children with a recalcitrant anterior cutaneous nerve entrapment syndrome is safe and successful

Introduction 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 < 18 years 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 15 years ± 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. Conclusion Anterior neurectomy is safe and successful in most children with abdominal pain failing a conservative treatment for ACNES. Type of study Treatment study. Level of evidence IV.