Objective To explore the effect of laparoscopic highly selective vagotomy (Hill) on the treatment for acute perforating duodenal ulcer. Methods In 19 patients with acute perforating duodenal ulcers, laparoscopic repair of the perforation, laparoscopic freeing of the vagus, cutting off of posterior vagal trunk, and highly selective resection of anterior vagal trunk were performed. Results In all 19 cases the operation was successful. No patient was converted into open highly selective vagotomy. Ulcer symptoms of 17 patients disappeared after operation, and gastroscopy in follow up after 6 months showed that the ulcers had healed. The postoperative ulcer symptoms of 2 patients were markedly relieved and were easily controlled by medication. Conclusion The treatment of acute perforating duodenal ulcer by laparoscopic highly selective vagotomy (Hill) has the advantages of minor trauma, rapid postoperative recovery, and good results, it is a good procedure for the treatment of perforating duodenal ulcer.