Chronic Abdominal Wall Pain: The MEPONE Approach to Treating ACNES in Victoria

For many patients across Melbourne and regional Victoria, chronic lower abdominal pain is a frustrating, invisible battle. When diagnostic workups like colonoscopies, gastroscopies, and CT scans come back completely clear, patients are often left without answers.

Frequently, the culprit isn’t an internal organ at all—it is Anterior Cutaneous Nerve Entrapment Syndrome (ACNES).

 

At Northern Surgical Care, Dr Ashok and our surgical team specialize in advanced, minimally invasive solutions for complex abdominal wall conditions. For patients suffering from debilitating ACNES, we utilize a cutting-edge surgical technique: the MEPONE technique (Minimally Invasive Extraperitoneal POsterior NEurectomy) using an eTEP retrorectus approach.

Here is what General Practitioners and patients need to know about this highly effective option available right here in Victoria.

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Understanding ACNES: The Overlooked Cause of Abdominal Pain

ACNES occurs when the terminal cutaneous branches of the intercostal nerves (T7–T12) become trapped, compressed, or scarred as they pass through the rectus abdominis muscle sheath.

• The Presentation: Severe, localized, sharp, or burning pain on one side of the abdomen.
• The Clinical Indicator: A positive Carnett’s sign—where abdominal pain intensifies or remains unchanged when the patient tenses their abdominal muscles.

When conservative management, such as local anesthetic or steroid injections, fails to provide permanent relief, surgical intervention becomes the definitive step forward.

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Moving Beyond Traditional Open Surgery

Historically, treating refractory ACNES meant an open anterior neurectomy. If that failed or the nerve pain returned due to deep scarring, an open posterior neurectomy was performed. However, traditional open re-operations come with clear downsides:

• Large, painful incisions.
• Disturbance of previous scar tissue.
• Increased risk of structural abdominal wall weakness or future incisional hernias.

To avoid these complications, our team approaches nerve entrapment by utilizing a highly sophisticated extraperitoneal surgical plane.

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What is the MEPONE Technique?

MEPONE stands for Minimally invasive Extraperitoneal POsterior NEurectomy. It utilizes an eTEP (enhanced-view totally extraperitoneal) approach.

If this sounds familiar, it is because this strategy shares its core anatomical and technological principles with the advanced TEP technique we use routinely to repair complex groin and abdominal wall hernias.

Instead of cutting through the front of the abdomen or entering the peritoneal cavity where the bowel resides, the surgeon accesses a hidden “tunnel” called the retrorectus space (the layer directly behind the six-pack muscle but in front of the deeper abdominal lining).

How the Procedure Works:

1. Targeted Entry: Working entirely inside this extraperitoneal plane under high-definition laparoscopic magnification, the surgeon navigates directly to the lateral border of the rectus sheath.
2. Proximal Nerve Isolation: Because the camera provides a highly magnified view, the affected intercostal neurovascular bundle can be identified before it enters the scarred or compressed zone.
3. Neurectomy and Prevention: The entrapped nerve branch is carefully isolated from its accompanying blood vessels, divided cleanly, and a small segment is resected. The remaining nerve ending is tucked away into the muscle belly to prevent the formation of a painful recurrent stump neuroma.

Key Takeaway for GPs: By dividing the nerve proximally within the retrorectus space, the MEPONE technique completely bypasses the zone of previous anterior tissue injury and chronic inflammation, leading to a much higher success rate in treating refractory pain.

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The Advantages of Laparoscopic eTEP Retrorectus Neurectomy

Choosing a minimally invasive extraperitoneal approach offers distinct clinical advantages for Victorian patients:

• No Intra-Abdominal Risks: Because the peritoneal cavity is never entered, there is zero risk of bowel injury, visceral adhesions, or post-operative ileus.
• Preserved Abdominal Structure: It completely preserves the structural integrity of the anterior rectus sheath, shielding patients from the risk of dynamic weakness or structural breakdown.
• Faster Recovery & Less Pain: Smaller keyhole incisions mean less post-operative reliance on heavy pain medications and a far quicker return to work and daily activities.
• Excellent Visual Clarity: The laparoscopic camera uncovers accessory or aberrant nerve branches that are frequently missed during blind, open explorations.

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Accessing Advanced ACNES Treatment in Victoria

Northern Surgical Care provides comprehensive assessment, diagnostic verification, and advanced keyhole treatments for chronic abdominal wall pain across multiple convenient Victorian locations.

Whether you are a patient seeking relief or a GP looking to refer a complex case, you can consult with our specialist team across Melbourne’s northern and western suburbs:

• Northern Suburbs: Access specialized care at Epping (Northern Private Hospital) or consult locally at our Wallan Medical and Specialist Centre and Sunbury (Goonawarra Medical Centre).
• Western Suburbs: We accept patients at Werribee (St Vincent’s Private Hospital) and our Point Cook Boardwalk Specialist Centre.
• Inner North: Consultations and procedures are also available at Coburg (John Fawkner Private Hospital).

Information for General Practitioners

If you have a patient with suspected or injection-proven ACNES who has exhausted first-line therapies, please review our medical team’s GP referral guidelines to expedite their priority surgical assessment.

Information for Patients

Chronic pain does not have to be a permanent fixture in your life. If you have been told your abdominal pain has “no known cause,” you may be a candidate for an extraperitoneal nerve decompression. Review our