Background: Post thoracotomy pain remains an important challenge for surgeons and patients. It affects respiratiory function, quality of life and limits patients carrying on with daily activities. We aimed at assessing the efficacy of using rib drill and transcostal sutures to close intercostal space to minimize post thoracotomy pain and respiratory complications. Patients and methods: Aprospective followup study, included 86 middle age patients operated through posterolateral thoracotomy for lung resection. Thoracotomy was reclosed using rib drill with passing transcostal heavy vicryl sutusres. All Patients were followed up during hospitalization period and for one month after discharge in postoperative pains score using the visual analogic pain scale and respiratory function using spirometry variable sanalysis [FVC(L), FEV1 (L), PEF (L\s) and FEV1\FVC(%)] compared to preoperative assessment. Results: The intensity of post thoracotomy pain significantly (p<0.001) decreased over time post operative with its lowest level after 1 month with mean of 0.63 ± 0.65. Comparing preoperative and postoperative spirometry variables, there was adecrease in all spirometry results at 30 days postoperative. However, it was non significant difference (p>0.05). Conclusion: Patients in our study experienced less post-thoracotomy pain immediately postoperative and after one month. Additionally, there was non significant reductions in the postoperative spirometry variables compared to preoperative results. Therefore, using drill and trancostal heavy vicryl sutures is recommended for thoracotomy closure in middle age patients.