Mayo Clinic Department of Surgery allows that surgeons unnecessarily operate on the most common of abdominal wall pain calling it 'neuroma' = anterior cutaneous nerve entrapment = treatment needed is only injection of 2% lidocaine = p Rochester, Minnesota

Mayo Clinic surgeons have a problem diagnosing, and correctly treating, the most common cause of abdominal wall pain = ACNES = abdominal cutaneous nerve entrapment syndrome.  This is a benign condition, where the nerve becomes 'entrapped,' or swollen, in anatomic sites where the nerve changes direction.

It commonly - the pain - occurs post-surgery in all abdominal incisions (including Pfannenstiel for childbirth), after extreme muscle exertion or sports, and can occur in children as well as elderly patients.  Bariatric surgeons should get educated on this.  So if it is wrongly diagnosed, the very young, and the very old, can lose abdominal sensory nerves unnecessarily to Surgical Pathology - as has been happening all too commonly at Mayo Clinic for the last 15 years - as Dr. Michael Sarr hasn't gotten the message about this syndrome.  

The Mayo Clinic Rochester misses this diagnosis all the time on the surgical service, trying to sell neurectomies, procedures, and get cases for students & residents - who when brought into the OR will just keep cutting as they have no idea what this 'syndrome' is - ask a Mayo medical student, intern, resident, or surgical attending about ACNES.  

None of them know how to do a Carnett's test, know the sensitivity, specificity or false positive & false negative rate of the test (common stats), or how to do the physical examination for this - the patient can usually put one finger on the exact source of pain.  No surgeon at Mayo Clinic examines the neuromuscular foramen of the abdominal wall - they just go schedule a surgical slot and do unnecessary pelvics on women patients - and the nerves are not in the vagina.  They don't even know the number of these anterior nerve foramen - or location - or where to find a diagram (Google).  No surgeon does a Carnett's test at Mayo Clinic, University Hospitals of Cleveland, or The Cleveland Clinic - they just cut.   

This condition has been recognized since 1926, and since 1972 a Family Practitioner - Dr. William V. Applegate - has put articles in SURGERY & other Journals (The Permanente Journal/Summer 2002/Volume 6 No. 3), hoping that surgeons will READ, RECOGNIZE, and not unnecessary REMOVE (the 3 R's) abdominal nerves with horrible incisions and closures.  

ACNES is never discussed on Rounds at Mayo Clinic, University Hospitals of Cleveland, or even Cleveland Clinic - 3 bastions of male ignorance, ego, and brainlessness.  And no surgeon ever does the recommended treatment for ACNES - that would mean losing an opportunity to cut unnecessarily. 

Almost all surgical literature, books & journal articles overlook ACNES in their differentials - it's not in William Silen's classic or any of the texts of General Surgery (Schwartz).  Abdominal wall pain is thus too often misdiagnosed as intra-abdominal pain, and the cause is right under the surgical fingertips - fingertips that haven't got a brain - and need the Wizard of Oz.     

Dr. Michael Sarr, a Chief of General Surgery at Mayo Rochester, doesn't know how to recognize this condition, and commonly rushes to the OR - he's always got a canceled slot - with a pre-op diagnosis of 'neuroma' having not done a Carnett's test or considered this diagnosis - especially in women - where he doesn't bother to scan, consult with Ob-Gyn or Medicine.  Sarr can't discuss or do a good exam, he talks in circles about the 'glory of Mayo Clinic' while scheduling the unnecessary surgery.  You consent to a 5 minute 'look,' and he has a major procedure instrument set on the table - it's on his OR card. 

Since 1998, Dr. Sarr been informed that he does this, with no change in how patients are evaluated for surgery at Mayo - Sarr unnecessarily neurectomizes these patients and then closes with a butcher job common mass closure.  MDs get neurectomized without Carnett's test - with no consent.  Dr. John Bundrick describes Carnett's test in Mayo Clinic Proceedings as 95% sensitive (false positive tests occur <5%).  Dr. Sarr Does not read Mayo Clinic Proceedings:  Dr. Bundrick's article can be found at (even non-medical people can access this) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012636/pdf/mayoclinproc_86_1_011.pdf.

Carnett's test is basically having the patient do an abdominal 'crunch' maneuver with the examiner pushing on the tender spot - an increase in pain with tensing of the muscles is diagnostic for abdominal wall pain - patients can try this at home with a friend/family member.  Or have the patient raise their legs with pressure on the trigger point.  If you inject with 2% lidocaine, and the pain is relieved, the diagnosis is made.  Really HARD test to do.  

Apparently it's hard for surgeons to do the proper administration of local anesthetic agent, 2% lidocaine, into the area of the nerve aponeurotic opening - you have to know your anatomy.  Ask a medical student/resident at Mayo Clinic the locations of the anterior abdominal wall neuromuscular foramen - there are 10 spots to be examined - they haven't had their cappuccino or latte yet. 

The injection is therapeutic to reduction herniation of the nerve (which surgery can't do), and diagnostic if it relieves the pain (this sorts the nerve pain from pain/swelling of a retained suture).  

Michael Rosen MD - the US hernia expert - doesn't have a clue about Carnett's test or injection treatment - it's not in his glossy picture ATLAS OF ABDOMINAL WALL RECONSTRUCTION.  Surgeons buy these huge expensive ATLASES, and carry them around to develop musculature, but don't read simple articles or learn patient exam neuromuscular foramen anatomy.  Why examine a patient when you can cut?  

HONORS on Surgical Clerkships always go to the medical student who does the most cutting, not the medical student who brings the articles on ACNES or make the right diagnoses for the patient - this needs to change starting at Mayo Clinic.  Any medical student who lets an operation continue that the patient did not consent to, should be FLUNKED their surgery clerkship.  No one at Mayo Clinic STOPS Dr. Sarr's unconsented for surgeries - not the OR NURSE, not the SURGICAL TECHNOLOGIST, not the ANESTHESIA GUY, and CERTAINLY not the RESIDENT or MEDICAL STUDENT.   

Nerve entrapments will have associated muscle spasms - which can be very painful - and the injection helps relieve this.  Dr. Sarr's common mass closure just worsens these muscle spasms if the patients are operated on - and he never sees the patient post-op to check the sensory loss.  The operations for ACNES worsen everything except Mayo Clinic RECEIVABLES.       

Common mass closure is a butcher closure that leaves the wound muscles/fascia under horrible tension, with horrible unusual deformity & sensory loss, and sets up a lifetime of pain and muscle spasms (worse than leaving the nerve entrapment alone).  One woman MD has requested a take-downs of these nonconsenting procedures for 15 years now - with no answer.  Chief Legal Counsel, Jill Beed-Smith has no plan for Mayo Clinic to do this - she hasn't had her neurectomy yet.  Please someone, schedule her. 

In the 1980s, all the common mass closures of surgical incisions were taken down at patient request - they may have less dehiscence (usually no better than layered closures), but at the price of terrible abdominal wall deformities and chronic pain.  Common mass closure was a bad idea in the 1980s, and an even worse idea in the 1990s.  Dr. Sarr has resurrected this horrible closure, and routinely closes his unnecessary neurectomies with it - a Frankensurgeon.  Dr. Sarr has the support of the Legal Department at Mayo Clinic in doing unnecessary neurectomies on patients = more procedures.  Jill Beed-Smith.

Women physicians contacting Dr. Sarr have their emails removed Administratively, so that they can't contact him.  Dr. Sarr will attempt to sue patients & physicians, for the defamation that he removed their nerves without a Carnett's test (truth), or without even considering the diagnosis of ACNES, or an anesthesia consult for an injection.  Patients don't consent to these neurectomies, don't get anesthesia consults, and get 'knocked out' so that they don't object in the OR.  Patients just ask for an exploration & closure to make a decision - Sarr continues and removes the nerve - he won't inject even intra-operatively, and wait 5 minutes to see if the pain is relieved.  And the residents are clueless with scalpel in hand, while the medical students are texting & twittering. 

Dr. Sarr admits that he has no consent for these 'neurectomy' procedures - Mayo Clinic does not have to get patient consent - and informed consent never happens.  Dr. Bundrick on the Medicine Service publishes the correct treatment of ACNES in Mayo Clinic Proceedings - but Dr. Sarr will not send the patients to him, or consult.  Contact Dr. Bundrick, and he doesn't reply or help (Dear John Letters go nowhere) - he just publishes the right treatment and has videos on youtube - his secretaries talk about the fact that they do 'teamwork.'  No one at Mayo Clinic knows the definition of 'teamwork.'  Dr. Sarr does not work with Dr. Bundrick + Dr. Bundrick does not work with Dr. Sarr = Teamwork.    

Dr. Bundrick needs to help educate the Surgical Service, and help all patients unnecessarily neurectomized obtain repairs of their abdominal wall and the undoing of all the over-the-top common mass closures.  This was unnecessary if Mayo Clinic physicians did any kind of 'teamwork.'  Women physicians who have been attempted to be sued for trying to 'educate' Dr. Sarr, should be apologized to - how to do ACNES correctly has been in the Surgical literature for the last 40 years - to treat with a 2% injection and this should be on Dr. Sarr's OR card - STOP THE GUY IF NEUROMA IS ON THE PRE-OP DIAGNOSIS.