Over the last decade 18 patients with thoracic outlet syndrome (T.O.S.) were treated at our department by scalenectomy through transverse supraclavicular approach.Preoperatively all of the patients had experienced pain, paresthesias and tingling of neck and shoulder with radiation to the ipsilateral arm, whereas 8 of them had additionally vascular symptoms.

Postoperatively (6 months – 2 years) 12 patients were still suffering or they had a deterioration of symptoms. 9 were male (80%) whereas 3 were female (20%).

Resection of the first rib through transaxillary approach was performed and six months later they all had returned back to work, reporting complete relief (80%) or significant improvement (20%).After 4 years of follow up there were no recurrences.

In one case there was a long thoracic nerve palsy that spontaneously recovered after 6 months.

Whilst the cause of recurrence remains controversial, many authors suggest that this is due to adhesions of scar tissue to the nerves and vessels at the axilla. Therefore, intervention should be planned and performed by an experienced surgeon, avoiding complications and minimizing tissue trauma.

In conclusion, prevention is the best way of managing recurrences; accurate clinical evaluation, careful preoperative planning and meticulous dissection are the cornerstones of a successful outcome.