Abstract: Aim: was to improve the efficiency of external drainage in patients with biliary tree obstruction by tumor process in the porta hepatis zone. Materials and methods: percutaneous transhepatic cholangiostomy under the combined sonofluoroscopic control with using on the first phase of the treatment of self-locking drainages pig tail №8Fr followed by external-internal drainage or endobiliary stenting were performed in 147 patients with «high» tumor block of the biliary tree. Results: depending on the extent of biliary occlusion there were from 1 to 6 drainages. «Big» post-manipulating complication encountered in one patient (0.7%) - migration of cholangiostomic drainage with the development of biliary peritonitis. «Small» complications (short-period haemobilia, migration of cholangiostomy amilazemiya at transpapillary insertion of an external-internal drainage) occurred in 20 patients (13.6%). Mortality rate was 6.1%. Death causes: common bile peritonitis (1 case), and the progression of hepatorenal insufficiency on the background of biliary decompression (8 cases). Conclusion: antegrade cholangiostomy at «high» tumor obstruction of the biliary tree is a necessary manipulation as in palliative biliary decompression, and in the preparation of the patient for radical surgery for Klatskin tumors. Satisfactory performance of postmanipulating complications and in-hospital mortality involve the use of special techniques for effective external and external-internal drainage of bile ducts. References 1. Witzigmann H., Lang H., Lauer H. Guidelines for palliative surgery of cholangiocarcinoma HPB (Oxford). Jun 1, 2008; 10(3): 154-160. doi: 10.1080/13651820801992567 PMCID: PMC2504365. 2. Rerknimitr R., Kullavanijaya P. Operable malignant jaundice: To stent or not to stent before the operation? World J. Gastrointest. Endosc. 2010 Jan 16;2(1):10-4. doi: 10.4253/wjge.v2.i1.10. 3. Paik W.H., Loganathan N., Hwang J.H. Preoperative biliary drainage in hilar cholangiocarcinoma: When and how? World J. Gastrointest. Endosc. 2014 Mar 16;6(3):68-73. doi: 10.4253/wjge.v6.i3.68. Review. 4. Liu F., Li Y, Wei Y, Li B. Preoperative biliary drainage before resection for hilar cholangiocarcinoma: whether or not? A systematic review. Dig. Dis. Sci. 2011 Mar; 56(3):663-72. doi: 10.1007/s10620-010-1338-7. Epub 2010 Jul 16. 5. Kawakami H., Kondo S., Kuwatani M., Yamato H., Ehira N., Kudo T., Eto K., Haba S., Matsumoto J., Kato K., Tsuchikawa T., Tanaka E., Hirano S., Asaka M. Preoperative biliary drainage for hilar cholangiocarcinoma: which stent should be selected? J. Hepatobiliary Pancreat Sci. 2011 Sep; 18 (5):630-5. doi: 10.1007/s00534-011- 0404-7. 6. Ustunda Y, Boyvat F. Debate continues over which method we should prefer for the preoperative biliary decompression in cases with hilar cholangiocarcinoma. J. Gastroenterol. 2012 Jan; 47(1):88-9; author reply 90-1. doi: 10.1007/s00535-011-0496-5. Epub 2011 Nov 15. 7. Nuzzo G., Giuliante F., Ardito F., Giovannini I., Aldrighetti L., Belli G., Bresadola F., Calise F., Dalla Valle R., D’Amico D. F., Gennari L., Giulini S. M., Guglielmi A., Jovine E., Pellicci R., Pernthaler H., Pinna A.D., Puleo S., Torzilli G., Capussotti L., Improvement in perioperative and longterm outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian
