Aim: A retrospective analysis was made of results obtained in 169 patients with axial transomphalic external biliary drainage, operated between 1984 and 1998. However, the authors’ experience with this method covers a total of 773 cases in which this type of drainage was used between 1966 and 1998. Method: The technique is described in detail. The use of the omphalic ligament provides a completely extraperitoneal trajectory for biliary drainage tubing inserted between the two peritoneal layers of the ligament. Results: Postoperative mortality and morbidity in the patients presented here were not related to the drainage procedure, but were related to the background illness, associated disturbances and the surgical procedures applied. Axial transomphalic biliary drainage has many indisputable advantages in comparison with other types of external biliary drainage. Indications and counterindications of the method are summarized. Conclusion: The technique is especially valuable because it protects biliary-digestive anastomoses and common biliary duct sutures, facilitating implantation of prostheses and reconstruction of the main biliary pathway, as well as benign and malignant stenoses.