Acute cholangitis of severe type (ACST) is caused by suppurative infection following acute biliary obstruction, characterized by sudden onset, rapid change of morbid condition, and high mortality rates. Non-surgical treatment should be initiated aggressively as soon as ACST is suspected or confirmed, and then selection of appropriate surgical procedure can be decided according to the conditions of the patients. With the development of minimally invasive technology and the improvement of medical science, reports on one-session surgical removal of cause of obstruction on the premise of unobstructed drainage have been available. In this paper, the authors present the current status of treatment of common bile duct stones complicated with ACST by minimally invasive techniques that mainly include endoscopic, percutaneous transhepatic biliary drainage and laparoscopic techniques.