Results of treatment of 697 elderly and senile patients with cholelithiasis and its complications were analyzed. It was established that decision on the rational surgical strategy in cholelithiasis patients of the older age group depended not on the patients' age, but on results of evaluation of their somatic status and the degree of preoperative correction, the presence and kind of complications of the main disease, and on the state of the bile-excreting system at different stages of diagnosing and treatment. The differentiated and substantiated strategy and the present day minimally invasive diagnostic and medical technologies considerably decrease risk of operative interventions, diminish the number of complications and thus improve the results of surgical treatment of patients of the older age groups having cholelithiasis.