Objective: To investigate the best treatment choice for obstructive mild acute biliary pancreatitis (MABP). Methods: The clinical data of 132 patients with obstructive MABP treated during 2008 to 2014 were retrospectively analyzed. Of the patients, 35 cases underwent minimally invasive surgery based on endoscopic retrograde cholangiopancreatography (endoscopic group), 43 cases underwent laparoscopic cholecystectomy and common bile duct exploration (laparoscopic group) and 54 cases underwent open surgery (laparotomy group). The relevant clinical variable among the three groups were compared. Results: In endoscopic group, laparoscopic group and laparotomy group, the time to relief of abdominal pain (3.31 d vs. 3.84 d vs. 7.65 d) and time for white blood cells to return to normal level (4.20 d vs. 5.35 d vs. 8.72 d) were statistically different between each of them (all P<0.05); in endoscopic group and laparoscopic group, the time for recovery of blood amylase (3.26 d vs. 3.53 d) and length of hospital stay (9.49 d vs. 9.30 d) showed no statistical difference (both P>0.05), but were all shorter than that in laparotomy group (4.35 d and 9.30 d) (both P<0.05). In the 3 groups, the cure rate was 100% and no death occurred, and the incidence of complications showed no statistical difference between them (P>0.05); the incidence of recurrent pancreatitis within one year after operation in endoscopic group (42.86%) was significantly higher than that in laparoscopic group (0.00%) and laparotomy group (1.85%) (both P<0.05), but showed no statistical difference between the latter two groups (P>0.05). Conclusion: For most cases of obstruction MABP, the laparoscopic approach is the preferred method to relieve biliary obstruction.