The initial treatment for the patient with primary or secondary spontaneous pneumothorax occupying less than 15% of the hemithorax is observation. And then the treatment with primary spontaneous pneumothorax greater than 15% of the volume of hemithorax is a simple thoracoscopic aspiration. However, the treatment with secondary spontaneous pneumothorax greater than 15% of the volume of hemithorax is tube thoracotomy. Conservative treatment for continuous air leakage with secondary spontaneous pneumothorax is instillation of a sclerosing agent( small amount of picibanil 3 KE). Surgical treatment for continuous air leakage with secondary spontaneous pneumothorax due to severe idiopathic pulmonary fibrosis (IPF) is intractable. We have experienced three cases in which surgical treatment is difficult in secondary spontaneous pneumothorax with underlying lung diseases. The first cases are a pneumothorax with a giant bulla or severe lung emphysema. Second cases are a pneumothorax with a fragile lung. Third cases are a pneumothorax with a hardened lung. We need devised surgical approaches to these cases.