In a retrospective review of 294 patients with spontaneous pneumothorax (398 episodes), 45 patients came to surgical treatment. The period of the study was 7 1/2 years, with a mean follow-up of 3 years in which there was no recurrence of pneumothorax after surgery. Operation consisted of simple excision of bullous lesions, usually located at the apex of the upper lobe, without pleurectomy. This simplified surgical approach has met with excellent result, indicating that pleurectomy is unnecessary in the treatment of this disease.