We have reviewed our experience with thoracobiliary fistulas due to biliary tract disease. Early diagnosis and treatment of subphrenic abscesses and bile duct obstruction will decrease the incidence of these fistulas. Once established, relief of biliary obstruction, subphrenic drainage, excision of the fistulous tract and appropriate supportive measures will decrease the morbidity rate and mortality of this rare but distressing condition. In our series, all of the patients ultimately had relief of the symptoms. There was no mortality.