The sole transcervical technique was used for rethymectomy in 3 patients, and the transcervical-subxiphoid-bilateral VATS maximal rethymectomy was used in 2 patients at our institution. These were 5 patients who had undergone previous unilateral VATS thymectomy elsewhere. Part of the upper poles of the thymus was discovered in all patients on rethymectomy. It might confirm a potential incompleteness of the unilateral VATS thymectomy as was described by Shigemura et al. [1]. Our results of follow-up of patients who underwent rethymectomy showed complete remission in 1/5 patients and improvement in 4/5 patients after a follow-up of 22–72 months (mean 51 months). The results of this small group, taken together with the results of our previous study with patients undergoing rethymectomy through resternotomy, show that for unknown reasons the repeated operation is much less effective than the primary procedures. They also stress the necessity to perform the initial thymectomy in the best possible way, preferably in the extended fashion with complete removal of the whole thymus and the surrounding fatty tissue.

The advantage of rethymectomy in our patients was the possibility to wean most of them from steroids and immunosuppressive medication.