ObjectiveTo compare clinical efficacy between transumbilical three-port laparoscopic surgery (TU-TPLS) and transumbilical single-incision laparoscopic surgery (TU-SILS) in repair of acute peptic ulcer perforation. MethodsThe patients with acute peptic ulcer perforation who underwent TU-TPLS or TU-SILS in Chengdu Second People’s Hospital Affiliated to Sichuan University from January 2022 to December 2024 were retrospectively collected, and then were divided into the TU-TPLS group and TU-SILS group. The operation time, postoperative 24 h incision pain score (visual analogue scale) , postoperative hospital stay, total hospitalization cost, incision scar score (Vancouver scar scale), comprehensive satisfaction, and postoperative complications were compared between the two groups. The statistical significance was defined as α=0.05. ResultsA total of 105 patients met the inclusion criteria were enrolled, comprising 50 patients in the TU-TPLS group and 55 patients in the TU-SILS. There were no statistically significant differences in baseline characteristics between the two groups, such as gender, age, body mass index, perforation site, perforation diameter, and Boey score (all P>0.05). Postoperatively, the TU-TPLS group demonstrated significantly lower visual analogue scale pain score at 24 h compared to the TU-SILS group [(2.34±0.63) score vs. (3.22±1.05) score, P<0.001] and significantly higher comprehensive satisfaction score [(7.60±0.86) score vs. (7.02±1.01) score, P=0.002]. However, no statistically significant differences were observed between the TU-TPLS group and TU-SILS group regarding operative time [(71.84±10.51) min vs. (69.78±7.98) min, P=0.257], postoperative hospital stay [(10.35±2.08) d vs. (9.96±1.75) d, P=0.310], or total hospitalization costs [(20 856.23±4 095.73) yuan vs. (19 988.83±2 933.43) yuan, P=0.212]. The incidence of umbilical wound infection was 1 case in the TU-TPLS group and 3 cases in the TU-SILS group (Fisher exact test, P=0.619). Postoperative residual intra-abdominal infection occurred in 2 cases in the TU-TPLS group and 1 case in the TU-SILS group (Fisher exact test, P=0.604). Incisional bleeding occurred in 0 cases in the TU-TPLS group and 1 case in the TU-SILS group (Fisher exact test, P>0.999). Furthermore, there was no statistically significant difference in the scar assessment score between the TU-TPLS group and TU-SILS group [(3.11±1.13) score vs. (2.92±0.70) score, P=0.301] at the 2-month postoperative follow-up. ConclusionsBoth TU-TPLS and TU-SILS have achieved good therapeutic effects in treatment of acute peptic ulcer perforation. However, TU-TPLS has more advantages over TU-SILS. TU-TPLS causes milder incision pain, leads to higher patient satisfaction, and does not require special equipment.