**5.4 Pleurodesis**

The American College of Chest Physicians, British Thoracic Society, and the Belgian Society of Pulmonology recommended surgical pleurodesis via thoracoscopy for air leak that persists more than 4 days or recurrence prevention at second occurrence [45]. Methods of pleurodesis have included mechanical abrasion with gauze or Marlex, instillation of tetracycline, pleural irritation with laser or cautery, and instillation of talc [46]. The addition of pleurodesis agents reduces the rate of recurrence in PSP. Alayouty et al. in a randomized controlled trial studied the efficacy of different pleurodesis agents. They reported that chemical pleurodesis is associated with less recurrence rate than mechanical abrasion (P < 0.001, evidence level 1b) [47, 48].
