Editing Pneumothorax (section)

=== Surgery - resect the cause and obliterate the pleural space ===

* Mostly need recurrent primary spontaneous PTX before considering VATS
* If blebs or bullae >1cm are seen, wedge resection is necessary
* Controversial as to whether VATS or limited thoracotomy are better. In bilateral disease, VATS is also reasonable.
* Mechanical abrasion of the parietal pleura
* Pleural space should be obliterated with apical parietal pleurectomy, pleural abrasion or chemical irritation
** Apical parietal pleurectomy - surgical fixation of the lung to the endothoracic fascia - good long-term results
** Pleural abrasion preferred for patients likely to need further thoracic surgery as it preserves the extra-pleural plane of dissection. Recurrence rate 2.3%
** Chemical pleurodesis - mostly talc (powder of hydrous magnesium silicate. Commercially available talc is free of asbestos. 
* Pleurodesis with talc is good in older patients or patients with malignancy, but surgery would be preferred in most patients.