Abstract: With the acceleration of aging society in China, acute obstructive suppurative cholangitis (AOSC) in the extremely elderly (≥80 years) patients has become a common and frequent acute abdominal disease, which seriously threatens national strategy of "healthy aging" in China. Endoscopic retrograde cholangiopancreatography (ERCP) is currently the mainstream treatment for AOSC, but emergency ERCP treatment for elderly patients with AOSC is limited. In recent years, laparoscopic surgery targeting laparoscopic transcystic common bile duct exploration (LTCBDE) has been an ideal treatment method, but it has a high surgical risk. The authors′ team has conducted in‑depth exploration into the advantages and disadvantages of ERCP treatment, strategies for repairing Oddi sphincter function, selection of laparoscopic surgical methods, and formulation of safety guarantee measures, and has carried out the technical improvements on LTCBDE, aiming to enhance the feasibility and safety of this surgical method in the treatment of AOSC in extremely elderly patients.