The majority of spontaneous pneumothorax is due to lung compression caused by rupture of the dirty pleura and air leakage into the chest cavity, while a few come from esophageal rupture or chest wall rupture. A characteristic of spontaneous pneumothorax is that it is prone to recurrent attacks, which often causes patients to suffer. Surgical treatment that neglects some details also often leads to a high recurrence rate after surgery. Usually, spontaneous pneumothorax is divided into four stages: Stage I: normal lung, no pulmonary blisters, accounting for 30-40%; Stage II: no pulmonary blisters, but adhesions between lung and pleura, indicating previous pneumothorax, about 12-15%; Stage III: pulmonary blisters less than 2 cm in diameter, about 28-41%; Stage IV: multiple pulmonary blisters larger than 2 cm in diameter, 17-29%. Surgical indications for spontaneous pneumothorax: I. First attack 1, persistent air leakage 2, lung cannot be reopened 3, bilateral pneumothorax 4, hemopneumothorax 5, tension pneumothorax 6, combined pneumothorax II, second attack 1, ipsilateral recurrence 2, contralateral occurrence of pneumothorax 3, surgical treatment The principle of surgical treatment of spontaneous pneumothorax is to remove the pulmonary blister and eliminate the pleural cavity to prevent recurrence. Traditional open-heart surgery for spontaneous pneumothorax has been gradually eliminated in clinical practice due to its long incision and large trauma. The current surgical treatment of pneumothorax mainly includes thoracoscopy, small axillary incision and small thoracoscopic-assisted incision. The success of spontaneous pneumothorax surgery depends on adequate artificial pleural adhesions, reasonable placement of chest tubes and cooperation of anesthesiologists with bulging lungs. The key to recurrence prevention in pneumothorax treatment is artificially causing extensive pleural adhesions. In all patients with pneumothorax, regardless of subpleural blisters, emphysematous pulmonary blisters, incomplete pleural adhesions, or even those with no abnormalities on the surface of the lung tissue, the dirty layer of the pleura is defective, which is the etiology of recurrent pneumothorax. Only extensive adhesions between the dirty layer and the wall pleura can effectively prevent recurrence. The proper placement of chest tube also directly affects the recovery of patients and the recurrence rate of pneumothorax. An ideal chest tube should allow for easy drainage of gas and fluid without interfering with lung reopening. The anesthesiologist, together with the pneumothorax, can break the visible or invisible fibrous wrapping and increase the compliance of the lung to facilitate postoperative lung reopening. This operation is particularly important in patients with prolonged pulmonary atrophy. Unfortunately, a considerable number of surgeons only pay attention to the ligation and resection of pulmonary blisters but neglect to completely create pleural adhesions, resulting in a high recurrence rate of pneumothorax in clinical practice. In addition, due to the widespread use of thoracoscopy in clinical practice, which is popular among patients because of its light trauma and small incision, many doctors have also started to use thoracoscopy to treat spontaneous pneumothorax. However, due to the lack of rigorous training in formal lumpectomy, thorough and effective adhesion creation cannot be achieved, which also easily leads to postoperative pneumothorax recurrence. Thoracoscopy, thoracoscopy-assisted small incision, and small axillary incision are all alternative treatments for spontaneous pneumothorax, but it is important to master the handling of relevant details during surgery, especially thorough and comprehensive pleural adhesion creation, so as to reduce the recurrence rate of postoperative pneumothorax and alleviate the patient’s pain.