In recent years there has been a steady increase in the number of diseases accompanied by obstructive jaundice and requires urgent surgical intervention. External bile drainage, in which the incidence of complications is 2.4—32.7% and the mortality rate is 0.4—13.8%, is done to resolve obstructive jaundice. Improved antegrade procedures, tooling, and in-depth study of the topographic anatomical structure of the liver and its vascular system increase the safety of surgical techniques, such as antegrade percutaneous transhepatic interventions. Objective. To define optimal surgical techniques for decompression of the biliary tract in patients with hepatopancreatobiliary diseases complicated by obstructive jaundice from the topographic anatomical structure of the liver, biliary tract, and vascular system. Subjects and methods. The results of treatment were retrospectively analyzed in 150 patients aged 29 до 83 years (mean age, 74.3±5.4 years) with obstructive jaundice. To relieve obstructive jaundice, the patients underwent percutaneous transhepatic external cholangiostomy. It is optimal to use two bile duct imaging methods during cholangiostomy: at the first stage, ultrasound imaging with an assessment of the topographic anatomical features of hepatopancreatobiliary zone, allowing bile duct cannulation, followed by x-ray control. If there are insufficient ultrasound data to assess the topographic anatomical features, patients should undergo spiral computed tomography (SCT). In our study, we canullated the ductal system through the left liver lobe, by puncturing the second segmental duct along on the left parasternal line, 3—6 cm from the costal margin, as well as we canullated the sixth segmental duct through the right lobe using an access point along the posterior axillary line in the eighth to eleventh intercostal space. When analyzing the outcomes of treatment outcomes in 150 patients with obstructive jaundice, the investigators estimated the following indicators: intraoperative blood loss, length of hospital stay, incidence of complications, and mortality rates in relation to the choice of the biliary tract puncture point, by relying upon the topographic anatomical features. Results. During puncture of the right and left ductal systems, the amount of intraoperative blood loss was 32±9 and 18±5 ml, respectively (p=0.029). There was postoperative bleeding from the puncture channel in the right and left lobes in 4 and 2 patients, respectively; bile leakage with a right or left access in 4 and 5 patients, respectively; suppuration of the site of drainage in 15 (10%); hepatic parenchymal hematoma in 2 (1.3%); pneumothorax in 1 (0.7%); and migration of cholangiostoma in 3 (2%). Thus, the incidence of postoperative complications was 24% and that after accessing through the right and left lobes was 26 and 21%, respectively (p=0.045). The mortality rates after external cholangiostomy were 5% and those after accessing through the right and left lobes were 6 and 4% (p=0.048). Conclusion. The safety of external cholangiostomy provides a clear knowledge of the topographic anatomical features of the hepatopancreatobiliary zone, which allow evaluation of preoperative SCT, pre- and intraoperative ultrasonography. It is advisable to choose an access point depending on further radical treatment tactics. When a laparotomic intervention is further planned, it is feasible to make access from the point located along the posterior axillary line in the eighth to eleventh intercostal space; in other cases, the access point located in the epigastric region along the parasternal line is safest from the standpoint of topographic anatomical features.