Spontaneous pneumothorax.

A ten-year clinical series of 219 patients with spontaneous pneumothorax is presented with an average follow-up of 9 years. The vast majority of the patients were young men with a ruptured subpleural bleb. A slight increase in the incidence was noted in the older age groups with tuberculosis and chronic bronchitis as compared with the earlier series from the same hospital. The primary treatment was conservative in 197 and surgical in 22 cases. Recurrence of the pneumothorax occurred in 55 cases (25%). Primary conservative treatment failed in 41 cases, yielding 118 patients to operative approach. None of the patients treated by operation (plication or resection and suture of the bleb) had a later recurrence. Five re-operations were necessary: four because of a prolonged air leak after the first operation and one for bleeding. Two patients died on account of their pneumothorax, which gave a mortality of 1%. On the basis of the experience obtained, intercostal tube drainage is recommended as primary treatment; if it fails, thoracotomy seems to offer a good permanent result.