Conservative treatment for recurrent secondary spontaneous pneumothorax in patients with a long recurrence-free interval

Primary spontaneous pneumothorax (PSP) is defined as a pneumothorax that occurs in patients without significant underlying lung disease and an apparent cause (1,2). Secondary spontaneous pneumothorax (SSP) is defined as a pneumothorax that occurs in patients with existing lung disease, such as chronic obstructive lung disease (COPD) or pulmonary tuberculosis (1-4). The goals of treatment for spontaneous pneumothorax (SP) are to fully expand the lung by evacuating air in the pleural space and to prevent recurrence (5-7). Management for SP includes observation, oxygen inhalation, aspiration, closed thoracostomy with or without pleurodesis, and surgery, which are differently applied depending on characteristics of SP, patient condition, and doctors (physicians vs. surgeons) (1,8). According to the American College of Chest Physicians (ACCP) and the British Thoracic Society (BTS) guidelines, the surgical indications for SP include a persistent air leak, contralateral or bilateral pneumothorax, hemopneumothorax, patients at high risk for occupational reasons, and recurrent episodes (9-12). However, there are substantial discrepancies in management and clinical practice when treating SP (3,9-11)