Simple suture as standard treatment of perforated ulcer has been doubted because of high postoperative morbidity and reoperation-rate due to recurrent disease. Prospective studies showed that definitive surgery can decrease morbidity without increasing mortality. Selection is the important point. Patients with risk factors and perforation of acute ulcer should be treated by simple suture, patients without risk factors and perforation of chronic ulcer by definitive surgery (SPV + suture).