Open thoracotomy, a surgical procedure involving a large incision in the chest wall, has long been utilized in the management of pneumothorax. This procedure allows direct access to the pleural space, enabling effective intervention for complex cases or when less invasive techniques have proven unsuccessful. Indications for open thoracotomy include large or recurrent pneumothorax, significant underlying lung disease, or traumatic pneumothorax with associated injuries. The primary advantage of open thoracotomy is its versatility, as it provides wide exposure and direct visualization of the pleural cavity, facilitating the identification and management of the underlying cause of pneumothorax. This approach allows for the removal of blebs or bullae, repair of lung lacerations, and treatment of associated injuries, resulting in comprehensive management. However, open thoracotomy is a major surgical procedure associated with potential risks and complications, including postoperative pain, longer hospital stays, and slower recovery. The decision to proceed with open thoracotomy should be carefully considered, taking into account the patient's clinical condition, extent of pneumothorax, underlying lung disease, and the expertise of the surgical team. As less invasive techniques, such as video-assisted thoracoscopic surgery (VATS), continue to advance, the choice between open thoracotomy and VATS should be individualized based on the patient's needs and available resources.