Objective To compare effects between laparoscopic operation and laparotomy in the treatment of acute colonic perforation, and to explore the safety of laparoscopic surgery. Methods A retrospective analysis was conducted on clinical data of 42 cases of acute colonic perforation treated in our hospital from January 2008 to December 2014, including 22 cases of laparoscopic surgery and 20 cases of traditional open surgery.The surgical treatment effects were compared between the two groups. Results As compared with the open group, the laparoscopic group had shorter operation time [(160.5 ±25.4) min vs.(210.3 ±45.6) min, t=-4.426, P=0.000], less amount of blood loss [(112 ±21) ml vs.(220 ±53) ml, t=-8.834, P=0.000], earlier enterostomy exhaust time [(4.2 ±1.2) d vs.(7.3 ±3.4) d, t=-4.016, P=0.000], less pulmonary infections [9.1% (2/22) vs.40.0%(8/20),χ2 =3.945, P=0.047], shorter total hospitalization time [(10.3 ±2.6) d vs.(15.6 ±2.4) d, t=-6.839, P=0.000], and lower costs of hospitalization [(2.26 ±0.45) ×104 yuan vs.(3.16 ±0.38) ×104 yuan, t=-6.966, P=0.000]. There was no significant difference in the perioperative mortality and wound infection rate between the two groups (P >0.05). Conclusion Laparoscopic surgery for acute colonic perforation has advantages of little surgical trauma, less bleeding, quick postoperative intestinal function recovery, low pulmonary infection rate, short hospitalization time, and low hospitalization costs, being an effective, safe, and feasible method worthy of clinical promotion.