The aim of the study was to compare surgical treatment results in cases of recurrent spontaneous pneumothorax following video-assisted thoracoscopic surgery (VATS) and thoracotomy. We assessed the recurrence rate after the procedures and postoperative complications, considering two patient groups.Material and methods. The study group was comprised of 127 patients subjected to surgical treatment due to recurrent spontaneous pneumothorax during the period between 1996 and 2005. The group of 43 women and 84 men was between 15 and 79 years of age (mean age: 37 years). Video-assisted thoracoscopic surgery was performed in 67 cases, while the remaining 60 patients underwent thoracotomy. We performed the excision of the emphysematous blebs or apex of the lungs in 96 patients, partial pleurectomy with mechanical pleurodesis in 73 patients, subtotal pleurectomy in 33 cases, decortication of the lung in 30 cases, and chemical pleurodesis in 13 patients.Results. Pneumothorax recurrence was significantly more frequent in the group of patients following the minimally-invasive approach (28% vs 8%). We observed no statistically significant differences considering patient gender in both groups. However, the VATS approach had a tendency to be performed in younger patients (average 33 yrs. in VATS vs 42 yrs. in the thoracotomy group). We performed partial pleurectomy and mechanical pleurodesis more often during VATS, while subtotal pleurectomy and lung decortication were performed more frequently during thoracotomy. The percentage of resections, considering emphysematous blebs or lung apexes was similar in both patient groups. We observed no differences considering the duration and amount of postoperative drainage, hospitalization period, or percentage of postoperative complications (pleural hematoma, prolonged air leak, residual pneumothorax) between both groups.Conclusions. Apart from the excision of emphysematous blebs, subtotal pleurectomy should be considered in cases of patients subjected to video-assisted thoracoscopy. Subtotal pleurectomy could decrease the risk of recurrent pneumothorax, while having comparable percentages of postoperative complications as those following mechanical pleurodesis.