Objective To determine the efficacy of laparoscopic and open neoplasty on elderly patients with duodenal ulcer perforation (DUP). Methods Totally 100 elderly DUP patients admitted in our hospital from March 2014 to March 2017 were enrolled in this study. According to the treatment, they were divided into laparoscopy group and open surgery group, with 50 patients in each group. The therapeutic efficacy, incidences of complications and serum motilin level were compared between the 2 groups. SPSS statistics 22.0 was used for data processing. Student’s t test or Chi-square test was employed for the comparison between groups according to the data types. Results The time of getting out of bed [(28.87±3.07) vs (38.02±4.22) h], length of hospital stay [(3.69±0.82) vs (5.75±1.03) d], time to first flatus [(15.08±1.63) vs (27.36±2.86) h], time to bowel sound [(64.58±6.62) vs (81.46±8.36) h], intraoperative blood loss [(52.45±5.27) vs (76.74±8.04) ml], and incidence of complications (10.00% vs 28.00%) were significantly lower in the laparoscopic group than in the open surgery group. The patients of the laparoscopic group also had higher serum motilin level in 1 d [(182.43±19.52) vs (233.59±25.47) ng/L] and 2 d [(156.37±16.24) vs (180.42±20.18) ng/L] postoperatively when compared with the other group (P<0.05). In 3 months’ follow-up, the excellent healing rate was obviously higher in the laparoscopic group than in the open surgery group (96.00% vs 80.00%, P<0.05). Conclusion Compared with open surgery, laparoscopic neoplasty effectively reduces the trauma and occurrence of complications in elderly DUP patients, and is beneficial for the postoperative recovery of gastrointestinal function. It is worth of further clinical promotion.