The results of selective operative treatment for perforated peptic ulcers in 93 elderly patients 60 years of age or older have been found to be similar to those in a large group of patients of all ages with selective operative treatment for perforated peptic ulcers (1,127 patients). Elderly patients with previous symptoms of acid-peptic disease who do not have serious associated diseases that increase the risk of operation or generalized peritonitis or localized abscesses in the peritoneal cavity can undergo definitive ulcer procedures for perforated peptic ulcers with satisfactory morbidity and low mortality rates. Simple closure or omental patch closure is performed when such contraindications to a definitive operation are present and can be expected to have a greater mortality for this reason. Gastrectomy for a perforated gastric ulcer and truncal vagotomy and hemigastrectomy for a perforated duodenal ulcer offer the best long-term results for elderly patients who are fit to undergo definitive operation.