Objective: Some concern still exists regarding long-term lung function following videothoracoscopic talc poudrage for primary spontaneous pneumothorax (PSP). We evaluated lung function at 5 years in a series of 100 patients surgically treated for PSP. Methods: Out of 1065 patients treated for PSP by means of videothoracoscopic talc poudrage from September 1995 to January 2006, we consecutively enrolled 50 patients (33 males, 17 females, mean age: 24.22 years, median age: 24 years; range: 13–40 years) (group A) with no recurrence for functional evaluation with measurement of static and dynamic volumes (FEV1–FVC–TLC–RV), and DLCO at 60 months after surgery. Fifty patients (35 males, 15 females, mean age: 23.56 years; median age: 22.5 years; range: 16–37 years) underwent same pulmonary function tests 5 years after simple drainage for recurrent PSP because of refusal of surgery (group B). Results: Pulmonary function tests showed (mean % value ± SD for group A vs group B): FEV1 93 ± 6.6 versus 95.4 ± 6.4; FVC 98 ± 6.5 versus 100.1 ± 6.9; TLC 91.7 ± 7.7 versus 94.36 ± 5.8; RV 97 ± 7 versus 99.2 ± 4.9; DLCO 91.4 ± 2.8 versus 91.98 ± 4.2. No patient in both groups showed FEV1 ? 80%. Analysis of mean difference of pulmonary function values was computed between group A and group B patients. Conclusions: No statistically significant differences in long-term lung function have been found between patients treated with pleural drainage only versus patients treated with videothoracoscopic talc poudrage for PSP. Lung function is not impaired by videothoracoscopic talc poudrage.