Of 496 patients treated surgically for acute gastroduodenal perforation, 144 were treated by simple closure, 317 by immediate subtotal gastrectomy, 22 by immediate hemigastrectomy and vagotomy and 13 by delayed subtotal gastrectomy. In our most recent experience with 225 consecutive resections, the postoperative mortality rate was no greater than that observed following elective subtotal gastrectomy for other complications of ulcer disease. A review of the late results indicated that the response of patients with this complication is similar to that of patients with other complications of ulcer disease treated in the same manner. It was concluded that a definitive surgical procedure should be employed as the operation of choice in properly selected patients.