BACKGROUND: Medical treatment for myasthenia gravis involves the use of anticholinesterase agents, immunosuppressive drugs, plasmapheresis, and gammaglobulin. However, these agents result in a complete clinical remission rate as low as 15%. Accordingly, thymectomy has become increasingly effective therapeutic procedure for myasthenia gravis, with reported complete clinical remission rates as high as 80%.METHODS: Between Jan 1998& Jan 2002, 20 patients underwent trans-sternal thymectomy for MG according to the described protocol. This involves sternotomy with excision of the entire thymus and pericardial fat from phrenic nerve to the other phrenic nerve. RESULTS: all patients improved, 50% of patients had complete remission, 30%pharmacological remission. CONCLUSION: the study advocates trans-sternal thymectomy as an effective therapeutic procedure for myasthenia gravis.