To establish time trends in surgical rates for peptic ulcer disease, all surgical departments in Sweden were requested to complete a questionnaire regarding elective operations for gastric and duodenal ulcers and emergency operations for ulcer perforations performed in 1956, 1966, 1976, and 1986. A total of 8558 operations were reported for these years. The incidence of elective surgery declined steadily, the rates being 72.1, 45.0, 31.9, and 10.7 per 100,000 inhabitants. The male:female ratio fell from 4.2 to 1.5:1, while the duodenal/gastric ulcer ratio remained virtually unchanged. The operation rate for perforation decreased by 50%, from 12.8 to 6.4 per 100,000 inhabitants. We conclude that there has been a dramatic decline in elective peptic ulcer surgery in Sweden that began long before the advent of fiberoptic endoscopy, highly selective vagotomy, or H2-receptor antagonists. The comparable decline in emergency procedures suggests that true changes in the incidence or severity of the disease have occurred. In the future the few patients still needing elective surgery for peptic ulcer may have to be served by a small number of specialized centers.