Videolaparoscopic cholecystectomy was performed in 324 elderly and senile patients with acute destructive cholecystitis, 220 (67,9%) of whom were with phlegmonous cholecystitis or gallbladder empyema, 104 (32,1%) - with gangrenous cholecystitis. In 83 (25,6%) cases acute destructive cholecystitis was complicated by paravesical infiltrate or abscess formation. Non-standard techniques of laparoscopic cholecystectomy were applied in 64 patients, particularly fundus-first cholecystectomy in 14 patients and subtotal cholecystectomy - in 50 patients. Conversion to open technique took place in 12 (3,7%) cases. Intraoperative complications were observed in 14(4,3%) patients, postoperative complications - in 25 (7,7%) cases, 2 patients died after surgery, that comprised 0,6% postoperative lethality. Results of laparoscopic cholecystectomy in elderly and senile patients (324 patients) in comparison with conventional surgeries (392 patients of the same age group) for acute destructive cholecystitis were studied. Due to analysis endovideosurgical methods for acute destructive cholecystitis in elderly and senile patients provide statistically significant reduction of operation time, decrease of number of postoperative complications (1,5-fold), considerable lowering of postoperative mortality (fivefold) and twofold shortening of hospital stay compared with similar criteria of open surgical techniques.