Abstract
Review of a large group of patients treated for spontaneous pneumothorax has revealed a progressively higher incidence of recurrence in the three periods studied, covering a span of seventeen years. During this time the immediate management of this entity has changed from simple bedrest plus occasional thoracentesis to the routine use of closed thoracostomy with water-seal suction drainage. Definite indications for operation have become established and include the following: (1) failure of prompt and complete re-expansion after closed thoracostomy; (2) one or more ipsilateral recurrences; (3) single recurrence with bilateral apical blebs; (4) simultaneous bilateral pneumothorax; (5) asynchronous bilateral pneumothorax; (6) single episode with apical lung cyst; (7) continued intrapleural bleeding. The operative procedure which is employed consists of anterolateral thoracotomy, apical wedge excision or over sewing of blebs, and the production of pleural symphysis by talc poudrage and pleural abrasion. There has been no postoperative recurrence of pneumothorax on the operated side.
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