Study purpose. To show the possibility of X-ray surgical correction of endoscopically difficult choledocholithiasis caused by calculi of the bile ducts formed on intraluminal foreign bodies. Materials and methods. The results of percutaneous transhepatic lithotripsy and lithoextraction in 32 patients with recurrent choledocholithiasis were retrospectively analyzed. In 20 patients, antegrade cholangiostomy was performed after an initial unsuccessful attempt to endoscopically treatment of recurrent choledocholithiasis under conditions of adequate transpapillary access to the bile ducts. In 12 cases, the indications for preventive cholangiostomy were the clinical manifestations of cholangitis, parapapillary diverticulum, or megacholocholithiasis. After transformation of the cholangiostomy drainage into the external-internal transpapillary biliary drainage, an effective papillotomy was performed in the «rendezvous» format. Results. Percutaneous transhepatic choledocholithotripsy and lithoextraction were effective in all 32 patients. During lithotripsy in 6 (18.8%) patients the ligature nature of recurrent choledocholithiasis was revealed. Fixing the calculus ligature was revealed only with its partial destruction. It was possible to reliably establish the ligature nature of choledocholithiasis before performing visually controlled lithotripsy in no case. In 5 cases of 6, the use of endourological scissors was required to remove the ligature. In 1 case, the ligature was removed by forced traction with an endourological «alligator» grip. In all 6 cases of ligature choledocholithiasis, the calculus formed on the nodule and free ends of the ligature, facing the lumen of the gall tree. There were no post-manipulation complications and deaths. Conclusion. Antegrade cholangioscopy allows not only to objectively verify ligature cholelithiasis, but also to safely remove causal ligature, and also to completely eliminate cholelithiasis under visual control, regardless of its prevalence and size of calculi.