Abstract The classical method of perforated peptic ulcers (PPU) treatment is the perforation repair, which can be performed both by laparotomy or laparoscopy. The authors of many studies have concluded that laparoscopic and «open» interventions are equally effective in PPU cases. Almost thirty-year long history of laparoscopic interventions for PPU is accompanied by the question: what kind of surgery should be undertaken for PPU complicated by diffuse peritonitis — laparoscopic or laparotomy? Laparoscopy for PPU and peritonitis is a well-grounded surgical strategy, but the main condition for its successful implementation is the mandatory availability of emergency laparoscopic surgery skills. Analysis of the literature data on this issue suggests that in the absence of the absolute contraindications to laparoscopy, an operation should always be beginning laparoscopically. In addition, laparoscopy can initially be used for the final diagnosis of urgent abdominal pathology and then be used as the main method of surgical treatment.