Background: External biliary fistula is the most common complication of surgery for liver hydatid cysts. Aim: To report the experience with the conservative management of external biliary fistula. Material and Methods: Retrospective analysis of medical records of patients operated for hydatid cysts, complicated with external biliary fistula, between 1985 and 2004. Results: In the study period, 554 patients were operated for liver hydatid cysts and in 58 (10.5%), an external biliary fistula appeared. In 90% of these patients, cysts were located in the right lobe and 30% were multiple cysts. Seventy seven percent of cysts were multivesicular, 10% were infected and 52% had a concealed cysto-biliary rupture. In 84% of patients, a conservative surgical approach such as marsupialization and partial excision of the peri cystic region was used. Mean hospital stay of these patients was 36.8 days, compared with 11.4 days among patients without fistulae. Conclusions: Among patients that require surgery for hydatid cysts, risk factors for biliary fistula should be sought and conservative surgical approaches should be avoided whenever possible