Barw Barw Medical Journal 2960-1959 2026 06 14 Surgical Outcomes Following First Rib Resection for Neurogenic Thoracic Outlet Syndrome: A Systematic Review of 1,334 Operated Sides 42 54 10.58742/bmj.v4i1.234 eng Fahmi H. Kakamad Department of Thoracic and Vascular Surgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq |Department of Clinical Sciences, College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. fahmi.hussein@univsul.edu.iq Saywan K. Asaad Department of Orthopedic Surgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq |Department of Clinical Sciences, College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. saywankakarashasaad@gmail.com Sanaa O. Karim Department of Nursing, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq |College of Nursing, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. sanaaokarim@gmail.com Abdullah K. Ghafour Department of Orthopedic Surgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. abdulllahkamalghafour@gmail.com Hiwa S. Namiq Department of Neurophysiology, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq |Department of Basic Sciences, College of Pharmacy, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. hiwashafiqnamiq@gmail.com Hawkar A. Nasralla Department of Scientific Affairs, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. hawkar.arf96@gmail.com Lawand A. Sharif Department of Orthopedic Surgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. lawandahmedsharif@gmail.com Choman S. Omer Department of Radiology, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. chomansabagomer@gmail.com Azad S. Hattam Department of Neurosurgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. azadstarhattam@gmail.com Shakew S. Mohammed Department of Neurosurgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. shakewsmohammed@gmail.com Omed M. Hussein Department of Rheumatology, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. omedmohammedhussein@gmail.com Huzaifa Hamid Ahmed Department of Orthopedic Surgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. huzaifahamidahmed@gmail.com Harun Amanj Ahmed Department of Thoracic and Vascular Surgery, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. harunamanjahmed@gmail.com 2026 04 02   Introduction Neurogenic thoracic outlet syndrome (NTOS) is the most common subtype of thoracic outlet syndrome and results from compression of the brachial plexus within the thoracic outlet. First rib resection (FRR) is considered the cornerstone of surgical management in patients with refractory symptoms, although postoperative outcomes remain variably reported. This systematic review aimed to evaluate the outcomes, complications, and recurrence rates of FRR in the management of NTOS. Methods A systematic review was conducted using Google Scholar, supplemented by artificial intelligence-assisted searches. Original studies reporting postoperative outcomes following FRR for NTOS were included. Data regarding patient characteristics, surgical approaches, postoperative outcomes, complications, and recurrence were extracted and analyzed descriptively. Comparative analyses between surgical approaches were performed using Chi-square testing. Results Nineteen studies involving 1,334 operated sides were included. Most studies were cohort studies (73.68%). Females represented 75.44% of reported patients. Successful postoperative outcomes were observed in 87.08% of analyzable cases. No statistically significant difference in success or recurrence rates was identified between the open approaches. A total of 170 complications were recorded among operated sides managed via the transaxillary approach. Pneumothorax was the most frequently reported complication in both the transaxillary (n = 99, 20.58%) and supraclavicular (n = 7, 2.68%) approaches. The overall recurrence rate was 1.50%. Conclusion First rib resection is a safe and effective surgical intervention for NTOS, yielding favorable outcomes with low recurrence across a broad range of operative approaches. Neither the choice of surgical approach nor the extent of rib resection significantly influences surgical success.