All patients aged 80 years or more admitted to the departments of general surgery in Ringkøbing county, Denmark, during one year were studied prospectively in order to investigate morbidity and mortality following laparotomy in this patient group. A laparotomy was performed in 94 patients (67% women), in 73% as emergency cases. More than half of the patients had important coexisting diseases, and in half of the patients the cause of laparotomy was malignant disease, mostly colorectal cancer, while perforated or bleeding ulcer, cholecystitis, appendicitis, diverticulitis and incarcerated hernias were the most common benign causes of laparotomy. Postoperative complications were seen in 43% of the patients with a total mortality rate of 22%, mostly due to cardiac problems. Coexisting disease and emergency operation significantly increased both morbidity and mortality, which varied from respectively 8% and 0% after elective laparotomy in patients without coexisting diseases to respectively 71% and 39% after emergency operations in patients with coexisting diseases. In conclusion, laparotomy carries a high risk in elderly patients, particularly in the emergency situation. Efforts must be made in these patients to correct and treat any coexisting medical disorder prior to surgery, and when possible to perform early surgery before an elective operation turns into an emergency problem. Also, the development of new surgical procedures with lower morbidity must be encouraged.