Purpose of Review <p>Peptic ulcer disease is a common process which effects millions of people worldwide. Complications of peptic ulcer disease such as perforation can present as a surgical emergency.</p> Recent Findings <p>The approaches to surgical management have evolved over time. Both open and laparoscopic techniques can be utilized. Further, large or giant perforated peptic ulcers may require more complex surgical approaches as they can be a challenge to repair.</p> Summary <p>As the treatment for perforated peptic ulcer disease has evolved, several therapeutic pathways can be pursued. In a select few, a non-operative approach can yield satisfactory results. In those that need surgery, expeditious repair of the perforation is required. There are several approaches which include both open and laparoscopic techniques as well as advanced options utilized for the patient that presents with a large or giant perforated ulcer.</p>