Hosseinian, Mohammad Ali
(Department of General Surgery, Emam Hosein Hospital, Shahid Beheshti University of Medical Sciences)
,
Loron, Ali Gharibi
(Department of General Surgery, Emam Hosein Hospital, Shahid Beheshti University of Medical Sciences)
,
Soleimanifard, Yalda
(Department of General Surgery, Emam Hosein Hospital, Shahid Beheshti University of Medical Sciences)
Background: Surgical treatment of thoracic outlet syndrome (TOS) is necessary when non-surgical treatments fail. Complications of surgical procedures vary from short-term post-surgical pain to permanent disability. The outcome of TOS surgery is affected by the visibility during the operation. In thi...
Background: Surgical treatment of thoracic outlet syndrome (TOS) is necessary when non-surgical treatments fail. Complications of surgical procedures vary from short-term post-surgical pain to permanent disability. The outcome of TOS surgery is affected by the visibility during the operation. In this study, we have compared the complications arising during the supraclavicular and the transaxillary approaches to determine the appropriate approach for TOS surgery. Methods: In this study, 448 patients with symptoms of TOS were assessed. The male-to-female ratio was approximately 1:4, and the mean age was 34.5 years. Overall, 102 operations were performed, including unilateral, bilateral, and reoperations, and the patients were retrospectively evaluated. Of the 102 patients, 63 underwent the supraclavicular approach, 32 underwent the transaxillary approach, and 7 underwent the transaxillary approach followed by the supraclavicular approach. Complications were evaluated over 24 months. Results: The prevalence of pneumothorax, hemothorax, and vessel injuries in the transaxillary and the supraclavicular approaches was equal. We found more permanent and transient brachial plexus injuries in the case of the transaxillary approach than in the case of the supraclavicular approach, but the difference was not statistically significant. Persistent pain and symptoms were significantly more common in patients who underwent the transaxillary approach (p<0.05). Conclusion: The supraclavicular approach seems to be the more effective technique of the two because it offers the surgeon better access to the brachial plexus and a direct view. This approach for a TOS operation offers a better surgical outcome and lower reoperation rates than the transaxillary method. Our results showed the supraclavicular approach to be the preferred method for TOS operations.
Background: Surgical treatment of thoracic outlet syndrome (TOS) is necessary when non-surgical treatments fail. Complications of surgical procedures vary from short-term post-surgical pain to permanent disability. The outcome of TOS surgery is affected by the visibility during the operation. In this study, we have compared the complications arising during the supraclavicular and the transaxillary approaches to determine the appropriate approach for TOS surgery. Methods: In this study, 448 patients with symptoms of TOS were assessed. The male-to-female ratio was approximately 1:4, and the mean age was 34.5 years. Overall, 102 operations were performed, including unilateral, bilateral, and reoperations, and the patients were retrospectively evaluated. Of the 102 patients, 63 underwent the supraclavicular approach, 32 underwent the transaxillary approach, and 7 underwent the transaxillary approach followed by the supraclavicular approach. Complications were evaluated over 24 months. Results: The prevalence of pneumothorax, hemothorax, and vessel injuries in the transaxillary and the supraclavicular approaches was equal. We found more permanent and transient brachial plexus injuries in the case of the transaxillary approach than in the case of the supraclavicular approach, but the difference was not statistically significant. Persistent pain and symptoms were significantly more common in patients who underwent the transaxillary approach (p<0.05). Conclusion: The supraclavicular approach seems to be the more effective technique of the two because it offers the surgeon better access to the brachial plexus and a direct view. This approach for a TOS operation offers a better surgical outcome and lower reoperation rates than the transaxillary method. Our results showed the supraclavicular approach to be the preferred method for TOS operations.
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제안 방법
In both techniques, the cervical bands were removed before the rib resection. All patients under- going the operation were evaluated monthly up to 6 months, and subsequently, every 3 months up to a total of 24 months. Among the group that underwent the transaxillary method, 7 patients underwent reoperation with the supraclavicular method because of the recurrence of complications.
대상 데이터
Recalcitrant functional impairment after 6 months of non-surgical treatment and progressive neurologic dysfunction were observed in 69 patients; therefore, they met our institute’s criteria for surgical therapy [16]. Four patients presented with vascular symptoms including coolness, pallor, and diminished pulse (arterial TOS) in 1 patient and swelling, uncomfortable heaviness, and distended superficial veins (venous TOS) in 3 patients. The rest of the patients were diagnosed with neurologic TOS; they reported an array of symptoms including numbness, pain, weakness, and paresthesia.
In this study, a total of 448 patients were studied;of these, 357 were females and 91 were males.Recalcitrant functional impairment after 6 months of non-surgical treatment and progressive neurologic dysfunction were observed in 69 patients; therefore, they met our institute’s criteria for surgical therapy [16].
Bilateral TOS was diagnosed in 26 patients, which increased the number of operations to 95.Sixty-three operations using the supraclavicular approach were performed on 48 females and 15 males.Thirty-two operations were performed using the transaxillary approach on 28 females and 4 males.
Sixty-three operations using the supraclavicular approach were performed on 48 females and 15 males.Thirty-two operations were performed using the transaxillary approach on 28 females and 4 males.Further details are presented in Table 1.
후속연구
This technique allows access to supraclavicular fat, which can be used for wrapping the plexus after neurolysis in order to reduce the probability of symptom recurrence. Although the supraclavicular approach seems to be the preferable method in most TOS operations, further studies are recommended to obtain more clinical evidence.
참고문헌 (23)
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