A transversal retrolective analysis of all patients undergoing surgical treatment for cholelithiasis and choledocholithiasis between 1980 and 1987 was performed. The aim of the study was to investigate risk factors for the development of postoperative complications and mortality in elderly patients. A group of 187 patients above 70 years old were comparatively analyzed with 962 younger patients (total group: 1,149). Medical records were evaluated with emphasis to the diagnosis, associated diseases, characteristics of the surgical treatment, postoperative complications and mortality. Fifty percent of the elderly patients presented one or more concomitant diseases which significantly contributed to their operative risk. Acute cholecystitis, choledocholithiasis and cholangitis were more frequently found in aged patients (p < 0.05). In this group more patients also required bile duct exploration (p < 0.005). Major complications occurred in 16% and nine developed wound infection (5%). Operative mortality was 5.3%. In contrast, operative mortality of patients under 70 years of age was 1.5% and postoperative complications occurred infrequently. Acute cholecystitis, congestive heart failure, a history of myocardial infarction, and liver insufficiency were found as specific risk factors in the elderly.