The various treatments of spontaneous pneumothorax in cystic fibrosis are examined over a 15-yr period. Open thoracotomy with pleural abrasion is compared to observation, tube thoracostomy, and tube thoracostomy with instillation of quinacrine. Open thoracotomy with pleural abrasion has been performed 31 times in 20 patients. Discussion centers around selection of patients, preoperative preparation, operative technique, and postoperative care and follow-up, including analysis of pulmonary function studies. In our experience, open thoracotomy with pleural abrasion is a safe and effective method that should be utilized in the management of pneumothorax in patients with cystic fibrosis.