Background. Echinococcosis is a zoonosis caused by the Echinococcus adult or larvae tapeworms. Surgery has been the mainstay for large cysts, those that are likely to rupture, or infected, or exerting an important mass effect, but it has been said to be impractical in patients with multiple cysts in several organs. The aim of this study is to report our strategy for the surgical resection or for the drainage of large (> 5 cm) and/or complicated liver and multi-organ hydatid cysts. Methods. From 1992 to 2012, 13 patients have been evaluated for open surgery or a minimally invasive approach for cystic echinococcosis. After Albendazole administration, liver cysts have been treated by pericystectomy in nine cases, partial pericystectomy in three cases, and in one case we preferred to consider the percutaneous drainage. In case of multiple extra-abdominal organ localization, we first treated the liver localizations. Results. There has not been operative or post-operative mortality. Follow-up has been done for 1 and ndash;10 years and has revealed no recurrence. Conclusion. Surgery could have satisfactory results among patients with single and multiple large (> 5 cm) cysts in multiple organs. In case of recurrence, adhesion to the inferior cava vein or when general conditions are poor, the percutaneous intracystic injection of 90% ethanol followed by the cyst drainage (PAIR) is strongly recommended. [Arch Clin Exp Surg 2014; 3(2.000): 102-106]