〔Abstract〕 Objective To compare and analyze the curative effect of gallstone preservation and cholecystectomy in the treatment of elderly patients with gallbladder stones and the influence of postoperative stress response. Methods A retrospective analysis of the clinical data and follow-up data of 140 elderly patients with gallbladder stones diagnosed and treated by the Second People's Hospital of Guangshui City from January 2017 to March 2019, and divided them into the gallstone preservation group and the gallbladder group according to different surgical methods, with 70 cases in each group. The gallstone preservation group was treated with gallstone preservation and the cholecystectomy group was treated with cholecystectomy. The postoperative stress response and complications were compared between the two groups. Results After surgery, the levels of white blood cells (WBC), neutrophils (NEUT), cortisol (Cor) and epinephrine (EP) in the two groups were higher than those before surgery, and the differences were statistically significant (P < 0.05); After the operation, the levels of stress indicators in the gallstone preservation group werelower than those in the cholecystectomy group during the same period, and the differences were statistically significant (P < 0.05). The incidence of postoperative complications such as incisional infection, bile leakage, biliary hemorrhage, and pancreatitis in the gallstone preservation group (7.14%) was lower than that in the cholecystectomy group (21.43%), and the difference was statistically significant (P < 0.05). Conclusion Gallstone preservation surgery can reduce the postoperative stress response of patients and reduce the occurrence of complications.