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Chronic Abdominal Pain After Previous Bariatric Surgery: Consider the Abdominal Wall

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Abstract

Background

Up to 30% of patients who undergo bariatric surgery experience recurrent abdominal pain within 3 years after the operation. Although some causes for persisting discomfort are well known, a small portion of patients may suffer from an abdominal wall pain associated with Anterior Cutaneous Nerve Entrapment Syndrome (ACNES). Aim of the present study is to discuss incidence, clinical presentation, and treatment outcome in patients with ACNES after bariatric surgery.

Methods

This retrospective observational cohort study analyzed electronically stored data of patients with ACNES having a history of bariatric surgery. All were treated for ACNES between 2011 and 2017 in a Dutch center of excellence for abdominal wall and groin pain. Success after treatment was defined as a minimal 50% drop in pain level using a Numeric Rating Scale.

Results

A total of 49 patients (female n = 44, median age 45 (25–63) years) were identified. Four (8%) experienced long-term pain relief after just one abdominal wall infiltration with lidocaine. Ten additional patients reported success after 2–5 injections. A total of 35 unresponsive patients chose to undergo a neurectomy that was successful in 27. Therefore, this step-up approach conferred an 84% success rate. Occurrence of ACNES after bariatric surgery was estimated at 1 in 100 patients.

Conclusion

ACNES should be considered in the differential diagnosis of ongoing pain following previous bariatric surgery. A treatment regimen including abdominal wall infiltrations using an anesthetic agent or a neurectomy is successful in a vast majority of these patients.

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Author information

Authors and Affiliations

  1. Department of Surgery, Máxima Medical Center, P.O. Box 7777, 5500 MB, Eindhoven/Veldhoven, The Netherlands

    Claire M. A. Heukensfeldt Jansen, Monica L. Y. E. Jacobs, Marc R. M. Scheltinga & Rudi M. H. Roumen

  2. SolviMáx, Center of Expertise for ACNES, Center of Excellence for Abdominal Wall and Groin Pain, Máxima Medical Centre, Eindhoven, The Netherlands

    Claire M. A. Heukensfeldt Jansen, Monica L. Y. E. Jacobs, Marc R. M. Scheltinga & Rudi M. H. Roumen

  3. Obesity Center Máxima, Máxima Medical Centre, Eindhoven/Veldhoven, The Netherlands

    Daniëlle S. Bonouvrie & Wouter K. G. Leclercq

  4. NUTRIM, Maastricht University, Maastricht, the Netherlands

    Nicky Janssen

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  1. Claire M. A. Heukensfeldt Jansen
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  2. Daniëlle S. Bonouvrie
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  3. Monica L. Y. E. Jacobs
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  6. Marc R. M. Scheltinga
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Correspondence to Monica L. Y. E. Jacobs.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Jansen, C.M.A.H., Bonouvrie, D.S., Jacobs, M.L.Y.E. et al. Chronic Abdominal Pain After Previous Bariatric Surgery: Consider the Abdominal Wall. OBES SURG 30, 2942–2948 (2020). https://doi.org/10.1007/s11695-020-04629-7

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  • DOI: https://doi.org/10.1007/s11695-020-04629-7

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