Indications after a first episode:
(1) prolonged air leak
(2) incomplete re-expansion of the lung
(3) associated single large bulla
(4) occupational risk (flight personnel, diver)
(5) absence of medical facility in a remote location
Relative indications after the first episode:
(1) tension pneumothorax
(2) hemopneumothorax
(3) bilateral pneumothorax
Indications after a second episode:
(1) ipsilateral recurrence
(2) contralateral recurrence
The nature of the surgical intervention depends on the underlying pathology:
(1) A large bulla can be resected.
(2) A persistent air leak can be stapled or sutured close.
(3) A bronchopleural fistula can be closed.
(4) Pleurodesis (adhesions between visceral and parietal pleura) can be performed either chemically or manually.
