**7. Summary**

To conclude, the current guidelines available for treatment of spontaneous pneumothorax would state that in cases of spontaneous pneumothorax, patients will be assessed for clinical status and size of pneumothorax. In a very small PSP pneumothorax with no clinical complaint, it would be reasonable to discharge the patient and follow up. All patients with SSP require hospital admission. In a sizable pneumothorax with symptoms, the BTS and ERS guidelines would recommend needle aspiration with chest drain insertion if failed. The ACCP guidelines would

**9**

*Indications of Surgery in Pneumothorax DOI: http://dx.doi.org/10.5772/intechopen.88640*

air flights.

**Author details**

Hany Hasan Elsayed

recommend a chest drain straightaway. If the pneumothorax persists for 3–7 days according to different guidelines, definitive treatment is required. The BTS, ACCP and ERS guidelines choose first-attack tension pneumothorax, bilateral pneumothoraces and special occupations (pilots and divers) as indications for definitive intervention after one attack of spontaneous pneumothorax, while the BTS guide-

All guidelines agree that second-attack ipsilateral and first-attack contralateral recurrent pneumothorax are indications for intervention. The management of firstattack pneumothorax is debatable in all guidelines and will range from conservative management up to performing a VATS for definitive treatment. This will depend on the clinical situation, availability of resources/personnel and patient wishing to avoid the relatively high chance of recurrence. With the advancement in VATS techniques and significant reduction in risk of recurrence with a VATS intervention, it could be reasonable to perform the procedure on the next available list. A VATS procedure should be the standard surgical procedure for pneumothorax patients, and an open thoracotomy is no longer considered the 'gold standard' in all guidelines. All patients with an attack of spontaneous pneumothorax need lifestyle modifications regarding their smoking status, sport activity and travelling through

Physicians and thoracic surgeons should be aware of the current available guidelines for management of spontaneous pneumothorax. Deviation from the guidelines, particularly regarding the time to refer patients for definitive treatment, is associated with higher patient morbidity (particularly developing an empyema),

increased hospital stay and higher medical costs.

Thoracic Surgery, Ain Shams University, Cairo, Egypt

provided the original work is properly cited.

\*Address all correspondence to: drhany.elsayed@yahoo.co.uk

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

lines add pregnancy and previous pneumonectomy as indications.
