A series of 232 consecutive patients underwent surgery for hydatid liver disease (age range: 12-85 years) in our Department of General Surgery from July 1979 to December 2002. The study group comprised all the 326 cysts treated; the cysts were solitary in 181 patients and multiple in 51. One hundred and forty-one patients (60.7%) underwent radical procedures (7 major liver resections, 3 wedge resections, 95 total pericystectomies, 36 subtotal pericystectomies) and 91 patients (39.2%) conservative procedures (60 partial pericystectomies, 30 marsupialisations, 1 endoscopic drainage). The morbidity rate was 14.8% with the radical procedures and 34.6% with the conservative procedures; in the former group biliary fistula was observed in 2.8% vs 25.2% in the conservative group. The mortality was almost the same in both groups (2.1%). Local recurrence was observed only with the conservative procedures (2.9%). The radical surgical procedures were associated with better morbidity, hospital stay and local recurrence rate. Partial pericystectomy carried a low risk of local recurrence and permitted suitable treatment. Resection of the salient dome was associated with substantial morbidity and a prolonged hospital stay.