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Innovative management of Anterior Cutaneous Nerve Entrapment Syndrome (ACNES): A meta-analysis and introduction of a
Carlos Balthazar da Silveira1, Snigdha Gulati2, Robert Easter3
1St. Joseph's Hospital and Medical Center, Department of Surgery, Phoenix, AZ, USA; Creighton University School of Medicine, Department of Surgery, Phoenix, AZ, USA.
Background:
ACNES is a pain syndrome caused by entrapment of distal branches of the intercostal nerves. Literature is heterogeneous in the management of this condition, and no standard of care is available. This study aims to provide a systematic review and meta-analysis of available treatments for ACNES, propose standardized nomenclature and a management algorithm.
Methods:
We systematically searched PubMed, Embase, and Cochrane Library from inception to August 2024 for studies analyzing interventions for ACNES. We analyzed non-operative and surgical outcomes, primary outcomes including treatment success, recurrence, and need for re-intervention, as well as complication rates, and proposed a standardized nomenclature and management flowchart. Our robotic approach was described.
Results:
Non-operative success rate was 35%. Surgery success rate was 94.45%, and recurrence after first surgery was 34.6%. Significant heterogeneity was observed in the definitions of different neurectomies, and our proposed definition incorporates the relationship of the dissection with the anterior sheath, and includes a robotic approach.
Conclusions:
Non-operative therapy for ACNES can provide both symptom relief and diagnostic clarity, but recurrence rate remains high. Despite surgery presented a superior efficacy, no direct comparative superiority between treatment modalities can be established based on the available evidence. Patients might fare better when care is individualized according to symptom severity, expectations, and predicted disability.
