Thorax 1983;38:737-743 Surgical experience in the management of spontaneous pneumothorax, 1972-82

ABsTRAcr In the past 11 years 233 patients have undergone 241 parietal pleurectomies for either recurrence of their spontaneous pneumothorax or failure to respond adequately to management by tube drainage. Major complications occurred in 3-7 % of cases, with transaxillary apical pleurectomy engendering significantly fewer complications than full pleurectomy through a posterolateral thoracotomy. The significantly larger number of minor complications, however, in patients undergoing full pleurectomy was largely due to the larger number of patients with chronic obstructive lung disease in this group. On the basis of our experience we advocate the use of transaxillary apical pleurectomy for the younger age group with recurrent pneumothoraces and a full pleurectomy in the older age group, who frequently present because of failure to respond satisfactorily to tube drainage during their initial pneumothorax and often have lung disease sec-ondary to chronic obstructive lung disease which is not confined to the apex of the upper lobe. De Vries and Wolfe ' have estimated that about one in 500 young men in the United States will develop a spontaneous pneumothorax. Ferguson et a12 calcu-lated the incidence of new cases of spontaneou