Abstract
Background
Some children with chronic abdominal wall pain or groin pain do not have an inguinal hernia but suffer from anterior cutaneous nerve entrapment syndrome (ACNES). Diagnosing ACNES is challenging, especially in children as a diagnostic gold standard is lacking. A paediatric questionnaire containing 17 simple items was earlier found to discriminate between abdominal pain due or ACNES or IBS. Scores range from 0 points (ACNES very unlikely) to 17 points (ACNES very likely). The present study investigates whether this 17-item questionnaire predicted treatment success in children receiving therapy for ACNES.
Methods
Children < 18 years who presented in a single institute between February 2016 and October 2021 with symptoms and signs suggestive of ACNES completed the questionnaire before intake and treatment. Treatment success after 6–8 weeks was defined as self-reported ‘pain-free’ (group 1), ‘ > 50% less pain’ (group 2) and ‘ < 50% less pain’ (group 3). Group differences regarding sex, age, BMI, symptoms duration and questionnaire scores were analysed.
Results
Data of 145 children (female 78%, mean age 14.7 ± 2.3 years, mean BMI 21.1 ± 3.9) were analysed. All children received a diagnostic trigger point injection using an anaesthetic agent, and 75.5% underwent subsequent surgery for untractable pain. The three groups were comparable regarding sex distribution, age, BMI and symptoms duration. In addition, questionnaire scores were not different (group 1: n = 89, mean score 13.4 ± 2.7, group 2: n = 24, 13.4 ± 2.3 and group 3: n = 32, 13.0 ± 2.7, p > 0.05).
Conclusions
Treatment success was attained in 78% of children undergoing surgery for ACNES. A simple questionnaire scoring items associated with abdominal pain did not predict treatment success.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Siawash M, de Jager-Kievit JWA, Ten WTA, Roumen RM, Scheltinga MR (2016) Prevalence of anterior cutaneous nerve entrapment syndrome in a pediatric population with chronic abdominal pain. J Pediatr Gastroenterol Nutr 62(3):399–402. https://doi.org/10.1097/MPG.0000000000000966
Scheltinga MR, Roumen RM (2018) Anterior cutaneous nerve entrapment syndrome (ACNES). Hernia 22(3):507–516. https://doi.org/10.1007/s10029-017-1710-z
Siawash M, Roumen R, Ten WTA, van Heurn E, Scheltinga M (2018) Diagnostic characteristics of anterior cutaneous nerve entrapment syndrome in childhood. Eur J Pediatr 177(6):835–839. https://doi.org/10.1007/s00431-018-3125-y
Armstrong LB, Dinakar P, Mooney DP (2018) Neurectomy for anterior cutaneous nerve entrapment syndrome in children. J Pediatr Surg 53(8):1547–1549. https://doi.org/10.1016/j.jpedsurg.2017.11.062
Scheltinga MR, Boelens OB, Tjon WE, Ten A, Roumen RM (2011) Surgery for refractory anterior cutaneous nerve entrapment syndrome (ACNES) in children. J Pediatr Surg 46(4):699–703. https://doi.org/10.1016/j.jpedsurg.2010.08.054
Siawash M, Maatman R, Tjon W, Ten A, van Heurn E, Roumen R, Scheltinga M (2017) Anterior neurectomy in children with a recalcitrant anterior cutaneous nerve entrapment syndrome is safe and successful. J Pediatr Surg 52(3):478–480. https://doi.org/10.1016/j.jpedsurg.2016.08.020
Markus J, Sibbing IC, Ket JCF, de Jong JR, de Beer SA, Gorter RR (2020) Treatment strategies for anterior cutaneous nerve entrapment syndrome in children: a systematic review. J Pediatr Surg. https://doi.org/10.1016/j.jpedsurg.2020.05.014
van Assen T, Boelens OB, Kamphuis JT, Scheltinga MR, Roumen RM (2012) Construction and validation of a questionnaire distinguishing a chronic abdominal wall pain syndrome from irritable bowel syndrome. Frontline Gastroenterol 3(4):288–294. https://doi.org/10.1136/flgastro-2012-100207
Siawash M et al (2019) Abdominal wall pain or irritable bowel syndrome: validation of a pediatric questionnaire. J Pediatr Gastroenterol Nutr 69(3):e65–e69. https://doi.org/10.1097/MPG.0000000000002366
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Ethical approval
In line with the European General Data Protection Regulation, a previously approved Medical Ethical Review Commission (METC) application within the MMC was used for this study.
Human and animal rights
All procedures performed in this studie involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standartds.
Informed consent
Informed consent was obtained in all patients.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
van Hoek, P.P., Gorter, R.R.R., Janssen, L.L. et al. The role of a simple questionnaire predicting treatment success in children with ACNES. Hernia 27, 15–20 (2023). https://doi.org/10.1007/s10029-022-02721-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-022-02721-8