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Background <p>Open anterior neurectomy for Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) necessitates targeted dissection of the anterior rectus sheath, potentially compromising abdominal wall integrity. Utilizing established eTEP (enhanced-view totally extraperitoneal) principles, this study introduces a novel minimally invasive extraperitoneal posterior neurectomy (MEPONE) technique. By accessing the retrorectus space, direct proximal nerve visualization is achieved while avoiding direct transfascial dissection at the entrapment site.</p> Methods <p>A retrospective, single-center analysis evaluated all patients who underwent MEPONE for conservatively refractory ACNES between May 2021 and October 2024 at Sykehuset Innlandet. The procedure mirrors the extraperitoneal dissection of eTEP ventral hernia repair to isolate and divide the intercostal nerve branches prior to their fascial penetration. Primary outcomes included operative times, abdominal wall-specific complications, and site-specific pain reduction (Numeric Rating Scale, NRS) at 3 and 12 months evaluated using Wilcoxon signed-rank tests.</p> Results <p>Twenty-one patients (14 female, 7 male) with a mean age of 44.4 ± 15.7 years and a mean BMI of 28.3 ± 6.1&#xa0;kg/m² were included. A total of 24 neurectomies were performed (including 3 staged procedures<b>)</b>. Mean operative time was 35.0 ± 9.3&#xa0;min. The mean preoperative NRS score decreased significantly from 6.9 ± 1.6 to 1.5 ± 2.0 at 3 months (<i>p</i> &lt; 0.0001) and 2.1 ± 2.0 at 12 months (<i>p</i> = 0.0007). Complete pain relief (NRS 0–1) was achieved in 9 patients (42.9%), with significant pain reduction (&gt; 50%) in an additional 7 patients (33.3%). One patient presented with an asymptomatic relaxation of the rectus abdominis muscle (Clavien-Dindo Grade I). No major complications occurred.</p> Conclusion <p>MEPONE is a safe and feasible technique for ACNES. It offers the advantages of minimally invasive surgery—avoiding peritoneal entry and minimizing soft tissue trauma—while delivering pain relief rates that fall within the range previously reported for open approaches, though comparative effectiveness remains unproven. It represents a valuable alternative in the surgical management of chronic abdominal wall pain.</p>

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Minimally invasive extraperitoneal posterior neurectomy for anterior cutaneous nerve entrapment syndrome (ACNES): Primary description of the MEPONE technique and clinical outcomes

  • 期刊论文

  • 发表日期：

    2026年6月15日

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  • Richard Fischer,
  • Jan Lambrecht,
  • Robert Vogel,
  • Björn Mück

摘要

Background

Open anterior neurectomy for Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) necessitates targeted dissection of the anterior rectus sheath, potentially compromising abdominal wall integrity. Utilizing established eTEP (enhanced-view totally extraperitoneal) principles, this study introduces a novel minimally invasive extraperitoneal posterior neurectomy (MEPONE) technique. By accessing the retrorectus space, direct proximal nerve visualization is achieved while avoiding direct transfascial dissection at the entrapment site.

Methods

A retrospective, single-center analysis evaluated all patients who underwent MEPONE for conservatively refractory ACNES between May 2021 and October 2024 at Sykehuset Innlandet. The procedure mirrors the extraperitoneal dissection of eTEP ventral hernia repair to isolate and divide the intercostal nerve branches prior to their fascial penetration. Primary outcomes included operative times, abdominal wall-specific complications, and site-specific pain reduction (Numeric Rating Scale, NRS) at 3 and 12 months evaluated using Wilcoxon signed-rank tests.

Results

Twenty-one patients (14 female, 7 male) with a mean age of 44.4 ± 15.7 years and a mean BMI of 28.3 ± 6.1 kg/m² were included. A total of 24 neurectomies were performed (including 3 staged procedures). Mean operative time was 35.0 ± 9.3 min. The mean preoperative NRS score decreased significantly from 6.9 ± 1.6 to 1.5 ± 2.0 at 3 months (p < 0.0001) and 2.1 ± 2.0 at 12 months (p = 0.0007). Complete pain relief (NRS 0–1) was achieved in 9 patients (42.9%), with significant pain reduction (> 50%) in an additional 7 patients (33.3%). One patient presented with an asymptomatic relaxation of the rectus abdominis muscle (Clavien-Dindo Grade I). No major complications occurred.

Conclusion

MEPONE is a safe and feasible technique for ACNES. It offers the advantages of minimally invasive surgery—avoiding peritoneal entry and minimizing soft tissue trauma—while delivering pain relief rates that fall within the range previously reported for open approaches, though comparative effectiveness remains unproven. It represents a valuable alternative in the surgical management of chronic abdominal wall pain.