This meta-analysis examined 2,732 patients with spontaneous pneumothorax undergoing bullectomy combined with either parietal pleurectomy (PP) or pleural abrasion (PA). Compared with pleural abrasion, parietal pleurectomy was associated with a significantly lower long-term recurrence rate of pneumothorax (odds ratio 0.56, 95 percent confidence interval (CI) 0.41–0.77). However, pleurectomy carried a higher perioperative burden: longer operative times (mean difference of approximately 16 minutes), greater intraoperative blood loss, higher postoperative drainage volume, longer chest-tube drainage duration, and longer hospital stays. Importantly, postoperative pain scores were comparable between the two procedures. For cardiothoracic and thoracic surgeons worldwide, this meta-analysis provides the most up-to-date pooled evidence comparing two common pleurodesis techniques in spontaneous pneumothorax surgery. It underscores a clear trade-off: parietal pleurectomy offers better long-term protection against recurrence, but at the cost of increased perioperative morbidity. These insights are highly relevant when tailoring surgical strategy, especially in patients with recurrent pneumothorax, complex bullous disease, or comorbidities, balancing recurrence risk against recovery burden and safety.