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Purulent pleurisy is a public health problem because of its frequency and poor prognosis, especially for forms diagnosed late and occurring in multitarred or immunocompromised patients. The surgery of pyothorax is not consensual regarding the timing as well as the choice of the approach and the surgical procedure. The surgical treatment includes many operative techniques and the indication depends on the stage of the pleurisy, the quality of the underlying parenchyma and the general condition of the patient. The latest studies have shown similar and even very satisfactory results with videothoracoscopic surgery as with open surgery using the classic thoracotomy. However, surgery for purulent pleurisy, like all thoracic surgery, also depends on the type of population in which it occurs.A multidisciplinary management (pulmonologist, thoracic surgeon, anesthetist, physiotherapist) is necessary to determine the right time for surgery and to avoid the passage to chronicity.