What percentage of pneumothorax needs operative management

Primary spontaneous Pneumothorax Usually due to rupture of apical pleural blebs, small cystic spaces that lie within or immediately under the visceral pleura Primary spontaneous pneumothorax commonly occur in tall, thin, adolescent men. Occur almost exclusively in smokers Approximately one-half of patients with an initial primary spontaneous pneumothorax will have a recurrence Treatment Initial recommended treatment : Simple needle aspiration If the lung does not expand with aspiration or if the patient has a recurrent pneumothorax, thoracoscopy with stapling of blebs and pleural abrasion is indicated. Thorascopy or thoracotomy with pleural abrasion is almost 100% successful in preventing recurrences. Small pneumothoraces (<20%) that are stable may be monitored of the patient has few symptoms Moderate (20-40%) and large (>40%) pneumothoraces nearly always are associated with persistent symptoms that cause physical limitations and require intervention Ref: Bailey and love 27th edition Pgno : 368