Introduction: Perforated gastric ulcer nearby gastrostomy tube in an absence of a good quality omentum present an intraoperative challenge. We herein presenting a laparoscopic falciform ligament repair of a perforated gastric ulcer in a patient with gastrostomy tube with a positive outcome.Presentation: A 54-year-old female with a history of throat cancer with chemoradiotherapy and PEG tube a year ago. She presented to ED with 4 hours history of severe diffuse abdominal pain referred to left shoulder. She had a fever 99.3-degree F, hemodynamically stable. The patient was a malnourished with moderate distress from worsening upper abdominal pain and tenderness. She was leucopenic with WBC 3.2. She was rresuscitated and IV antibiotics was initiated. CT scan abdomen and pelvis showed free air in the abdomen.Procedure: Diagnostic laparoscopy revealed generalized peritonitis from an perforated gastric ulcer near the gastrostomy tube. Giving the poor quality of the greated omentum, we utilized the falciform ligament for repair of such perforated gastric ulcer.The abdomen was irrigated with warm saline and two Blake drains were placed. Postoperativly the patient did well and discharged home on day 2. After a 6 weeks course of proton pump inhibitor and cytoprotective medications, an Esophagogastroduodenoscopy revealed complete healing of the perforated gastric ulcer. Antral mucosal biopsy of the antral mucosa was negative for H pylori.Conclusion: Laparoscopic repair of perforated gastric ulcer with falciform ligament is safe and feasible. Falciform ligament repair should be place in the armamentarium of repair of perforated peptic ulcer when the omental repair is not feasible.