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Spontaneous pneumothorax is a common disorder with an incidence of between four and nine cases per 100,000 per year. Tube thoracostomy is the usual initial treatment and has been successful in most patients. The greater liability of pneumothorax to recur constitutes a special problem since the chances of a further recurrence increase with the number of episodes. The effective way to resolve the pneumothorax and prevent recurrences is surgical excision of the pathological lesion related to its onset (blebs or bullae) associated with pleural surface fusion. We submitted 133 patients, 113 males and 20 females (median age 26, range 12–37 years) to video-assisted thoracoscopic surgery (VATS) procedures for primary spontaneous pneumothorax. Nineteen were operated on for persistent air-leak after first episode, 114 for recurrent pneumothorax; four patients were operated on for contralateral episode after the first intervention. In 107 operations out of 137 (78%), blebs or bullae were identified and submitted to stapler resection; every patient underwent pleural abrasion. Persistent air-leak for more than 7 days (median 9, range 7–12) in six (4.3%) and bleeding in three out of 137 (2.2%) operations were encountered. Two patients out of six were submitted to revision minithoracotomy because of a copious air-leak: not previously identified leaking lesion was

Primary spontaneous pneumothorax. Is video-assisted thoracoscopy stapler resection with pleural abrasion the gold-standard?