• Experienced surgeons recommend different approaches and operations for thoracic outlet compression syndrome. I reviewed my recent 76-patient series (55% had excellent results; 35%, good; and 9%, failure), series reported by others, and the results of a national survey of complications of the transaxillary first-rib resection reporting 273 partial or complete postoperative brachial plexus injuries, 52 of which failed to recover completely. The difficulties with diagnosis, variability of results, and the potential of serious neurologic sequelae suggest reevaluation of indications and techniques of surgical therapy. Operation should be reserved as a last resort. Modern results with scalenectomy (not simple division of the muscle) suggest its use with reservation of first-rib resection for failures.
(Arch Surg 1982;117:1437-1445)