With the increasing aging of the population, we are encountering more and more patients over 80 years old with symptomatic gallbladder stones, and many of these patients have underlying diseases such as coronary heart disease, diabetes mellitus, and hypertension. The treatment of symptomatic elderly people is a very difficult problem. The elderly are in great pain and often express their wish for treatment, but the decision to operate is mainly made by their children, who are often caught in a dilemma because they want to completely solve the patient’s pain on the one hand, and are worried about whether the patient can withstand the surgery and recover afterwards on the other. Some physicians are also concerned about the risk of operating on such a patient and the stress involved. Our experience has been that in the case of very elderly patients with gallstones, the first step is to evaluate the patient’s condition, and most patients are able to tolerate the surgery and recover well. The main surgical approach is laparoscopic surgery, which is less invasive and has a faster recovery. In addition to delicate intraoperative operations, attention needs to be paid to matters such as appropriate reduction of pneumoperitoneum pressure, and the elderly cannot afford the risk of reoperation. Open surgery is available for those who are not suitable for laparoscopic surgery. Although almost all of the ultra-senior gallbladder stone patients operated in our hospital are discharged successfully, it does not mean that these patients are free from surgical risks or have little surgical risks. The decision to operate on ultra advanced gallbladder stones depends on various factors, such as the patient’s condition, hospital conditions, the skills of the anesthesiologist and surgeon, and family factors.