The results of treatment of 171 elderly and senile patients with complicated forms of cholelithiasis are presented. Staged surgical treatment, taking into account the developed criteria for assessing the severity of the condition of patients and the predicted risk of developing postoperative complications with the use of preliminary minimally invasive decompression interventions on the biliary tract, performed in 42.2% of patients in the main group, made it possible to stop purulent- cholemic intoxication and improve the results of subsequent radical operations. In 15.6% of patients, these interventions were the final method of treatment. The priority staged use of minimally invasive interventions made it possible to significantly reduce mortality, postoperative purulent-septic and extra-abdominal complications (3.1%, 12.4% and 29.9%, respectively), while in the comparison group these figures were 8.1%, 32. 4% and 41.9%.