Trial reportUpdates in surgery2025
To resect or avulse first rib in management of neurogenic thoracic outlet syndrome: a randomized controlled trial.
Trial report in Updates in surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
1 author.
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Abstract
introductionNeurogenic thoracic outlet syndrome (nTOS) is commonly treated with first-rib resection, a procedure linked to postoperative complications, but its necessity remains debated among experts, highlighting the need for further research. This randomized controlled trial aims to compare conventional first-rib resection with the avulsion method to identify the most effective surgical approach.
methodsThis single-center, randomized, group-sequential trial compared two surgical approaches for treating nTOS. Participants were randomly assigned to undergo first-rib resection (Group A) or first-rib avulsion (Group B), with both groups blinded to treatment allocation. The University of Sulaimani granted ethical approval and obtained written informed consent. Inclusion criteria included nTOS patients requiring surgery, excluding those with other TOS types, cervical ribs, clavicular fractures, or other complications. Outcome measures included pain scores, numbness, and patient satisfaction at multiple time points. Statistical analysis was performed using SPSS and Microsoft Excel.
resultsA total of 48 female patients were enrolled (23 in Group A, 25 in Group B). The mean age was 32.58 ± 7.23 years, and the average operation duration was 48.27 ± 13.95 min. Group B had significantly longer ribs (P < 0.001). Both groups showed significant pain and numbness reduction, with no significant differences in outcomes (P = 0.647, P = 0.839). At 6 months, 92.0% of Group B and 87.0% of Group A patients recommended the surgery.
conclusionAlthough statistically not significant, first rib avulsion may offer a viable alternative to resection for nTOS, providing comparable pain relief and functional recovery with reduced invasiveness.
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