TRANSAXILLARY FIRST RIB RESECTION FOR THORACIC OUTLET SYNDROME

Surgical therapy of thoracic outlet syndrome (T.O.S.) is highly contro versial. In contrast to many large series, recent literature reports a moderate to poor outcome following surgery. The aim of the present st udy is to evaluate the efficacy of transaxillary first rib resection i n the treatment of T.O.S. Over the past twelve years 106 first rib res ections were performed on 92 patients. Neurological complaints predomi nate (63%), while arterial and venous symptoms account for 22 and 15% of the symptoms respectively. Preoperative screening consisted of a th orough interview and clinical examination, chest and spine X-ray, dupl ex-ultrasonography, angiography on indication, E.M.G. and a neurologis t's consultation. Standard treatment was transaxillary first rib resec tion as described by Roos and OWENS. Eighty-five patients (92%) attend ed a follow-up examination with a mean follow-up of 63.2 months. All p atients 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 wo rse complaints than before surgery. In contrast to many other series a nd in accordance with some recent critical series we conclude that fir st rib resection is often not effective in relieving T.O.S. A renewed focus on conservative treatment seems justified with surgery serving a s a very last resort.