For the definite treatment of primary spontaneous pneumothorax(PSP), thoracoscopic bleb obliteration with pleural adhesive procedure is generally accepted as a standard. But additional pleurodesis is potentially useless procedure on the parietal pleura for treating visceral pleural disese. Furthermore, pleural symphysis could deteriorates normal pleural physiology and cause chronic pain. According to our previous study, stapling resection of the bulla without pleurodesis gave comparable result in recurrence comparing with articles with additional pleurodesis. The purpose of this study is to evaluate surgical outcome of thoracoscopic surgery with or without pleural abrasion and to know whether adhesive procedure is essential in the management of PSP.

Inclusion Criteria:

• recurrent pneumothorax
• bilateral pneumothorax
• total collapse/tension pneumothorax
• previous history of contralateral pneumothorax
• visible bulla on simple X-ray
• special occupation/situation
• air leakage more than 2 days with drainage catheter for 1st attack patients

Exclusion Criteria:

• patient refusal and reoperation case