Surgery for simultaneous bilateral primary spontaneous pneumothorax: when and how?

Although primary spontaneous pneumothorax (PSP) is common in adolescents and young adults, simultaneous bilateral primary spontaneous pneumothorax (SBPSP) is an unusual and potentially life-threatening condition with limited data on its incidence in the literature. There are evidence-based guidelines for the management of PSP, whereas the specific treatment strategy is not clearly defined in SBPSP despite clinical practice recommendations that surgery should be offered at the first episode. Currently, for most thoracic surgeons worldwide, video-assisted thoracic surgery (VATS) has taken a leading role in the treatment of PSP, due to its well-known advantages including less pain, better cosmetics, and faster recovery. In this article, we aim to explore the aspects of epidemiology, pathophysiology, diagnosis, management, and evolution of surgical approaches related to SBPSP.