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Background: In the absence of treatment with conservative therapy for thoracic outlet syndrome (TOS), surgery is performed to remove the operating pressure. This study evaluated the characteristics, complications, and outcomes two surgical procedures in patients with thoracic outlet syndrome. Methods: This retrospective, descriptive, analytical study was conducted in Alzahra Hospital (Isfahan, Iran) during 2001-10. Of approximately 120 patients with TOS who had surgery during the mentioned period, 47 persons were allocated to two groups. In group 1 (n = 16), the tension was constant and dynamic and the first rib was completely removed at once. In group 2 (n = 31), the tension was altering and the rib was chopped and removed. Symptoms, complications, and outcomes of surgery were extracted from patient records. The collected data was then compared between the two groups. Findings: Males and females constituted 23.4% and 76.6% of the studied population, respectively. The mean age was 38 years. Before the surgery, signs and symptoms were in the left side in 21 patients (44.7%), in the right side in 18 patients (38.3%), and in both sides in 8 patients (17%). Postoperative discomfort was reported by 35 persons (74.5%). On the other hand, 12 patients (25.5%) did not have discomfort after surgery. While 14 patients (29.8%) were completely satisfied with the outcome and 19 (40.4%) were satisfied despite having mild symptoms, 13 patients (27.7%) were dissatisfied. In addition, the two groups were not significantly different in terms of recovery rate and postoperative complications. In group 1, 75% of patients had postoperative discomfort (mild to severe) but 62.5% considered the surgery as excellent or good. In group 2, 74.19% of patients had postoperative discomfort (mild to severe) but 80.58% of them considered surgery to be excellent or good. Conclusion: Although recovery rate after surgery was not significantly different between the two groups, transaxillary procedure seems to be safer due to less harm to vascular and nervous elements and gradual removal of the rib. [ABSTRACT FROM AUTHOR]