Transaxillary first rib resection for thoracic outlet syndrome.

Surgical therapy of thoracic outlet syndrome (T.O.S.) is highly controversial. In contrast to many large series, recent literature reports a moderate to poor outcome following surgery. The aim of the present study is to evaluate the efficacy of transaxillary first rib resection in the treatment of T.O.S. Over the past twelve years 106 first rib resections were performed on 92 patients. Neurological complaints predominate (63%), while arterial and venous symptoms account for 22 and 15% of the symptoms respectively. Preoperative screening consisted of a thorough interview and clinical examination, chest and spine X-ray, duplex-ultrasonography, angiography on indication, E.M.G. and a neurologist's consultation. Standard treatment was transaxillary first rib resection as described by Roos and Owens. Eighty-five patients (92%) attended a follow-up examination with a mean follow-up of 63.2 months. All patients were examined by an independent observer and the resumption of pre-illness activity was recorded. Only 52% of the operations turned out to be successful. All other procedures resulted in identical or worse complaints than before surgery. In contrast to many other series and in accordance with some recent critical series we conclude that first rib resection is often not effective in relieving T.O.S. A renewed focus on conservative treatment seems justified with surgery serving as a very last resort.