Introduction:Perforated peptic ulcer (PPU) continues to be one of the very serious surgical emergencies, inflicting considerable morbidity and mortality. Laparoscopic repair has, therefore, become the elective surgical treatment; however, controversy still exists regarding the timing of the intervention. This study thus attempts to compare clinical outcomes between early laparoscopic repair (≤12 hours) and delayed laparoscopic repair (>12 hours) of PPU. Methods:A prospective observational cohort study was conducted at a tertiary care center. 180 patients included with PPU were randomized into early (n=90) and delayed (n=90) repair groups. The studies were reviewed for patient demographics, operative parameters, postoperative outcomes, and complications. A multivariate analysis was conducted to determine predictors of adverse outcomes. Results:Early repair showed much less operative time (85.4±22.6 min vs 102.8±28.4 min, p=0.001), conversion rate (4.4% vs 10%, p=0.042), and hospital stay (5.4±1.8 days vs 7.2±2.4 d, p=0.001) respectively. The early repair group had significantly lower rates of wound infection (5.6% vs 13.3%, p=0.021). Duration of time before oral intake (2.8±0.9 vs 3.6±1.2 days, p=0.008) and time to return to work (12.5±3.2 vs 15.8±3.8 days, p=0.002) were also favorable in the early repair group. In multivariate analysis, age >60 years (OR 2.34, 95%CI 1.45-3.78), delayed repair (OR 1.86, 95%CI 1.22-2.84), and ASA score ≥3 (OR 2.45, 95%CI 1.56-3.84) were found to be independent predictors for complications. Conclusion: Early laparoscopic repair of PPU is associated with better operative outcomes, faster recovery, and fewer complications compared to delayed repair. However, patient factors including comorbidities and hemodynamic status should guide the final timing decision.