Introduction. Extrahepatic bile duct injury causes block of bile outflow into the intestine, leading to biliary hypertension, cholemia, endogenous intoxication, and liver function disturbances. Reduced hepatic clearance for substances produced in the gut is accompanied by accumulation of different water-soluble (ammonia, phenols, mercaptans) and albumin-soluble toxins (aromatic amino acids, free fatty acids, endogenous benzodiazepines and false neurotransmitters etc.). It is believed that all of the toxic metabolites accumulated in the plasma cause disturbance in hepatic function and impair metabolic processes. This condition is associated with the development of life threatening complications such as hepatic encephalopathy, cerebral edema, coma, renal failure, pulmonary edema and collapse. Modern detoxification technologies. In recent years, extracorporal detoxification methods were widely used for the active excretion of toxic metabolites from the blood and tissue deposits. Also, some other methods such as intraportal drug administration, exchange transfusion, plasmapheresis, hemodialysis and peritoneal dialysis, lymphatic methods were proposed. The effectiveness of these methods is still discussed among different scientists, as sometimes complications exceed a benefit which limits their use in clinical practice. Also some other proposed methods including such as portal blood arterialization, cross circulation exchange transfusion, were not been widely used in practice due mostly for technical complexities of the procedures and the risk of development of severe complications in patients. Main toxic metabolites have accumulated in the blood of patients during hepatic dysfunction associated with plasma proteins, in particular albumin, but a number of compounds (e.g., ammonia, creatinine) are not bound with plasma proteins and are water-soluble. On this basis, the blood purification method in hepatic failure must meet the following requirements: • ensure removal of protein-bound and water-soluble toxins; • maintain normal acid-base and electrolyte balance; • the method must maintain its efficacy in long term use; • cause minimal side effects and complications. Plasmapheresis meets all of the above criteria which allows partial or total removal of the plasma of the patient with all the contained toxic metabolites and replacing it with adequate amount of fresh donor plasma, amino acid solutions, protein, and albumin. Types of plasmapheresis and indications for use. Depending on the application of the plasmapheresis, it can be classified into centrifugal (gravitational), when the blood is centrifugally separated into components in accordance with their specific gravity, and membranous, when plasma separation is carried out on a membrane having pores with a diameter of 0.2-0.8 mm, and filtarional in which the centrifugal force is used to improve the filtration efficiency of the plasma. Futhermore plasmapheresis can be used for more complex procedures such as - plasmasorbtion, immunoabsorbtion, cascade plasmapheresis, crio-apheresis et al. Plasmapheresis as a universal efferent method allows to delete all substrates found in plasma, regardless of solubility (lipid or water-soluble), molecular weight (low, medium, and high molecular weight compounds) and presence and magnitude of electrostatic charge of a molecule. Capacity of plasmapheresis to effectively remove the broad spectrum toxic metabolites allows it to be used in the treatment of acute hepatic dysfunction, as a comprehensive treatment of jaundice of various origins. Typically, the method is used for the treatment of symptoms in hepatic failure, such as jaundice, neurological disorders (hyperbilirubinemia, increased activity of transaminases, hypoproteinemia, increased creatinine and urea et al.) and in septic complications. For the first time in Russia, plasmapheresis were used in patients with obstructive jaundice and liver failure as early as in 1977 by Y.M. Lopukhin showing significant decrease in blood bilirubin and to improve subjunctive condition of patients. Y.M. Dederer recommended 3-4 cycles of plasmapheresis as preoperative preparation of patients with obstructive jaundice which can effectively remove toxic metabolic substances and enable to perform a surgery in a more favorable conditions. A.I. Agureev and colleagues (1989) used plasmapheresis in 42 patients with obstructive jaundice and reported a reduction of bilirubin by 15-30%. The effectiveness of plasmapheresis in detoxification decreased when bilirubin concentrations was below 100 mmol/l and gradually increased with the increase of bilirubin in high concentrations. After the procedure, laboratory findings show a decrease in the concentration of intermediate molecules from 0.31 to 0.24 units. E.G. Abdullayev and colleagues used plasma exchange in patients with obstructive jaundice, and noted a decrease in intermeiate molecule concentrations by 40%, bilirubin level by 60%, and decrease in the activity of transaminases and alkaline phosphatase by 35-40%. The authors recommended plasmapheresis in the preoperative and postoperative periods as an effective way to combat with cholemic intoxication, acute liver failure and residual endotoxicosis, which significantly reduces the risk of acute liver failure and allows to expand the scope of surgical procedures. I.M. Povzhitkov and colleagues show the reduction of bilirubin in blood by plasmapheresis at an average of 49.2%. A.I. Lobakov and colleagues noted the decrease in the concentration of direct bilirubin under the influence of plasmapheresis by 21.4±2.1%. Kimata H and colleagues, applied plasmapheresis in experimental studies in dogs with obstructive jaundice noted that plasmapheresis may shorten the jaundice and can improve liver function after treatment of obstructive lesions in the biliary tract. As plasmapheresis is able to remove microbes, toxins, degradation products, immune complexes, K.V. Lapkin and colleagues consider its appropriate use in the treatment of obstructive jaundice complicated by acute inflammation in the gallbladder or bile ducts in which intoxication is caused not only hyperbilirubinemia, but also by sepsis. Conclusion. The literature data shows the use of plasmapheresis in hepatic failure and obstructive jaundice, and indicates a high efficiency of the method and the broad possibilities of its use in clinical practice. Plasmapheresis can reduce symptoms of cholemic intoxication, hepatic encephalopaty, blood bilirubin, and the concentration of intermediate molecules, reducing the activity of transaminases and alkaline phosphatase. The use of plasmapheresis in obstuctive jaundice caused by choledocholithiasis, according to many authors, has a pronounced detoxifying effect, improves the prognosis of treatment, highly effective in preoperative preparation of patients with severe holemic endotoxemia which helps stabilize the activity of cytolytic and cholestatic process, improving the protein-synthetic function of the liver. Nonetheless, there are still a lot of questions regarding indication for the number of sessions required for plasmapheresis in the preoperative and postoperative patients with cholemic intoxication. Further research is needed to improve efficiency of the method by reducing the amount of plasma substitution and reinfusion of purified plasma.