Recurrent thoracic outlet syndrome

Recurrent symptoms of thoracic outlet syndrome have been reported following every type of surgical treatment, whether it is a first rib resection, scalenectomy, or a combined approach. Typically an overall recurrence rate of 15% to 30% has been reported. Nearly 20% of reccurent cases whose primary surgery is a single procedure require secondary surgery. However, a recent review of cases performed at the author's institution confirms that when a reverse combined approach is the primary surgery (a transaxillary first rib resection followed by and immediate transcervical anterior and medial scalenectomy), the recurrence rate drops to 5% to 10%, and the need for secondary surgery is less than 1%.