Aim of investigation. Choice of the optimal method of treatment in patients suffering from calculous cholecystitis and its complications taking into account operational risk and modern diagnostic means and low-invasive technologies. Material & methods. Results of 4380 cholecystectomies were analyzed including: from laparatomy access - 1598, by laparoscopy method - 2604, mini-access - 178.2799 (63,9%) patients were operated for chronic calculous cholecystitis and 1581 (36,1%) - for acute cholecystitis. Among patients with acute cholecystitis 601 (38%) had catarrhal form of gall-bladder inflammation, 791 (50%) - phlegmonous cholecystitis and 189 (12%) - gangrenous cholecystitis with bladder wall destruction. Results. Clinical-laboratory findings determined in different forms of gall-bladder wall inflammation can not be determining in the choice of terms and method of operation. US data were analyzed in 1152 patients with different degree of gall-bladder inflammation. At this, a high efficacy of US was proved concerning a degree of inflammatory changes in the gall-bladder wall. Taking into account high self-descriptiveness of US in the estimation of a degree of inflammation in the gall-bladder a "selective active" tactics in acute cholecystitis was developed. It is proved that cholecystectomy from laparatomy access has the greatest negative effect on the cardio-vascular and respiratory systems and laparoscopic intervention is easier transmitted by patients as lesser traumatic even comparing to mini-access cholecystectomy. At the increase of the rate of operations with use of low invasive technologies a decrease of both specific complications from 13,7% to 1,3% and non-specific complications from 5 and 4% to 0,8% was observed. Total postoperative lethality has made 1,6%. In chronic calculous cholecystitis postoperative lethality has made 1,1%. At this, rate of nonspecific postoperative complications resulted in lethal outcome made 1% and specific - only 0,1%.