Efficacy of surgical closure versus indomethacin for treatment of patent ductus arteriosus in symptomatic neonates is an ongoing controversy. In recent years, surgical closure has been performed in the neonatal intensive care unit rather than the operating room in some centers, creating further controversy. In a retrospective study of the charts of 115 sequential patent ductus arteriosus surgical closures performed in the neonatal intensive care unit in premature infants, we found no surgical morbidity or mortality. Ninety-nine of these infants of less than 33 weeks gestational age were evaluated for various factors that might influence outcome. All were operated on within 72 hours of diagnosis, with an extra-pleural approach and metal clips used for closure of the ductus. All infants were extubated at an average of 33 weeks in each age group studied unless they had underlying severe bronchopulmonary dysplasia. We conclude that surgical closure of the symptomatic patent ductus arteriosus in neonates is safe and 100% effective, with none of the reported complications of indomethacin therapy, and should be the treatment of choice in neonates aged less than 33 weeks (gestational age) at birth with symptomatic patent ductus arteriosus. Closure performed in the neonatal intensive care unit eliminates transport risks and is ultimately safer and easier than transport to an operating room.