Despite the rather high level of surgical technique, anesthetic and resuscitation care, traditional operations still represent a serious aggression for patients with purulent cholangitis, especially in patients of older age groups with severe comorbidities. The specific objectives of the treatment of acute cholangitis and biliary sepsis are: urgent minimally invasive decompression of the bile ducts, which eliminates the source of infection, adequate antibiotic therapy, hemodynamic and respiratory support, immunocorrection, nutritional support and methods of extracorporeal detoxification.