Objective To explore the value of 3D laparoscopic gastric perforation repair surgery for patients with gastric ulcer complicated with gastric perforation. Methods A total of 80 patients with gastric ulcer combined with gastric perforation were selected from January 2022 to January 2025 at Maojian District People's Hospital, Shiyan City, and randomly divided into two groups, each containing 40 cases, following the random number table method. Those who received traditional open gastric perforation repair surgery were included in the control group. Those who received 3D laparoscopic gastric perforation repair surgery were included in the observation group. The following indicators were compared between the two groups： postoperative gastrointestinal function recovery time （time to return of bowel sounds, time to first flatus, and time to first defecation）, postoperative day 3 intestinal mucosal barrier function indicators （diamine oxidase, D-lactic acid, and endotoxin）, and clinical prognosis indicators （surgery time, intraoperative blood loss, length of hospital stay, and incidence of complications）. Results The recovery time of gastrointestinal function was shorter in the observation group than in the control group （P<0.05）. On postoperative day 3, the levels of serum diamine oxidase, D-lactic acid, and endotoxin in the observation group were all lower than those in the control group （P<0.05）. Prolonged operation time, but less intraoperative blood loss, shorter postoperative hospital stay, and lower complication rates were observed in the observation group than in the control group （P<0.05）. Conclusion Using 3D laparoscopic technology for perforation repair can significantly promote the recovery of gastrointestinal motility in patients with gastric ulcer complicated by gastric perforation, maintain the function of the intestinal mucosal barrier, reduce the risk of postoperative adverse events, thereby optimizing overall prognosis, and showing good prospects for widespread application.