الفهرس 
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Abstract
Primary spontaneous pneumothorax (PSP) is the presence of air in the pleural cavity without any underlying pulmonary disease. The incidence of PSP was reported as 18–28/100.000 in men and 1.2–6/100.000 in women, ∼1.2–18/100.000in population. Most authors believe that PSP results from spontaneous rupture of a subpleural bleb or bulla. However, only a portion of patients with PSP could be found with blebs or bullae in imaging or at the time of surgery. Based on the consensus of the American College of Chest Physicians, it suggests that patients with the second occurrence or persistent air leaks (＞4 days) undergo surgery for PSP And patients who are at risk (Scuba divers, divers, pi- lots, etc.) are recommended to be operated promptly at the first occurrence. Treatment of PSP depends on many factors such as patient’s clinical presentation, the size of the pneumothorax, and history of previous attacks. The surgical treatment of PSP is based on two principles: resection of the parenchymal blebs or bullae, and obliteration of the pleural cavity. Pleurodesis is the creation of fibrous adhesions between the visceral and parietal layers of the pleura, thus obliterating the pleural cavity.
Therefore, the aim of this work was to compare mechanical (brushing the pleural surface) with combined chemical (insufflation of talc powder) and mechanical methods after thoracoscopic bullectomy as regard the efficacy, recurrence rates and postoperative hospital stay in patients with primary spontaneous pneumothorax. This prospective comparative observational study was conducted on 40 patients with primary spontaneous pneumothorax categorized into two equal groups, group (1) includes patients undergoing mechanical pleurodesis after
Summary
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thoracoscopic bullectomy. group 2 includes patients undergoing combined