Background & Objectives: Reports of open-cholecystectomy (OC) or laparoscopic cholecystectomy (LC) under general anaesthesia (GA) in the surgical treatment of gallbladder disease are common, but those performed under local anaesthesia (LA) are much more limited, especially for old aged patients unfit for GA. This study tried to determine the safety and success of Mini-Cholecystectomy under local anaesthesia for symptomatic gallstone disease in old aged patients unfit for GA. Patients & Methods: Since January 2009 to October 2012, eighty-five patients with gallstone disease scheduled for Mini-Cholecystectomy under local anaesthesia were included in this prospective study in Azadi teaching hospital. Sixty-three (74.1%) patients were females, with a median age of 76.5 years (range, 67–93). All of the patients had evidence of acute cholecystitis on ultrasonic examination. MC was performed by a standardized technique and under the combination of local anaesthesia (1% xylocaine without adrenaline) and intravenous administrations of fentanyl (0.001–0.002 mg/kg) and midazolam (0.05–0.1 mg/kg). Results: The median operative time was 40 minutes (range, 35–64). Most of the patients underwent the operation successfully without significant discomfort. Cholecystectomy was done successfully in 83 (97.6%) patients, giving a success rate of 97.6%. while cholecystostomy was performed in the remaining 2 (2.4%) patients because of the severe adhesions that rendered minicholecystectomy very difficult. The median hospital stay was 2.6 days (range, 2–7). Conclusions: Mini-Cholecystectomy under local anaesthesia is an effective surgical procedure for old aged patients with symptomatic gallstone disease who are unfit for GA.