BACKGROUND: The study aims to establish which surgical technique used for the repair of perforated peptic ulcers is associated with more favorable outcomes. METHODS: A retrospective chart review of the patients who underwent surgery for perforated peptic ulcers at the Mayo Clinic Rochester campus between 2004 and 2021 was performed. RESULTS: The final analysis included 277 patients: 182 suture closure of the perforation, 55 patch-only repairs, 15 gastrectomies with reconstruction, 14 wedge resections, and other techniques in 11 patients. There were no leaks in patients who had stapled wedge resection. Among patients with repair of the perforation (n=237), three variables associated with the leak on univariate analysis were included in a logistic regression model. All three were independently associated with a leak: lack of suture closure of the perforation (OR 7, 95% CI 2.5-19.1), immunosuppression (OR 5.5, 95% CI 1.7-17.6), and lactate levels (OR 1.4, 95% CI 1.1-1.7). CONCLUSION: When both sutured and patch-only closure techniques are feasible for a perforated peptic ulcer, sutured closure is associated with a lower risk of leakage. However, given our study's retrospective, single-institution nature, the findings should be interpreted cautiously.