The success of the eradication treatment for Helicobacter pylori in managing ulcer disease has further refined the indications for ulcer surgery. More patients are spared unnecessary surgery and its untoward sequelae. It is intriguing that surgery has been effective, given that Helicobacter pylori infection is the underlying culprit. Recent studies show that the prevalence of Helicobacter pylori infection remains high after a vagotomy but is more markedly reduced following a partial gastrectomy. Such a reduction may be due to the removal of distal stomach, which is the usual site of infection. In addition, bile appears to be bactericidal to Helicobacter pylori. The association between Helicobacter pylori infection and perforated duodenal ulcer has not been completely settled. A recent study demonstrates that male gender and positive Helicobacter pylori status are independent factors that are associated with recurrent duodenal ulcer after surgery for perforation. Hence, eradication therapy should be given to any patient who has a Helicobacter pylori infection, after surgery has been performed for perforated duodenal ulceration.