Open surgery of ulcer perforation still represents the treatment of choice in 2001. This procedure allows a safe approach to the ulcer site and exact excision of the border of the ulcer in order to reach tissue with good vascularisation. In pre-, intra- and post pyloric ulcer perforation the gastric outlet can be palpated after suturing in order to avoid stenosis. In gastric outlet obstruction or large perforated ulcers gastric resection can be performed. Open surgery allows an exact lavage of all quadrants of the abdomen in order to remove all sequelae of peritonitis. According to the current study laparoscopic procedures have no advantages compared to open surgery for ulcer perforation. Conservative treatment includes the risk of safety of diagnosis and difficulties in the continuous clinical monitoring as well as significant disadvantages in case of delayed laparotomy.