Persistent external biliary fistula was a common sequel of operations on the gallbladder in the early days of biliary tract surgery. In 1894, Murphy1pointed out that in 201 reports of cholecystostomies collected by Courvoisier, Riedel and himself, a permanent external fistula had obtained in 31 per cent of the cases. In only 3 per cent was obstruction in the common bile duct responsible for the continued external discharge of bile; in the remaining 97 per cent the explanation of the persistent fistula was to be found usually in faulty surgery; viz., in the suture of the mucous membrane of the gallbladder to the skin or the fixation of the gallbladder to the abdominal wall in the closure of the wound. Today, persistent external biliary fistula occurs usually as the result of an overlooked obstruction in the biliary tract when the gallbladder was operated on. Since cholecystectomy has supplanted