AbstractA series of 39 consecutive patients with proven hepatic hydatid disease have been followed from the time of presentation to Westmead Hospital with 6 monthly ultrasound examinations. In the 32 patients having surgery in this unit, it has been found that the standard operation—evacuation of the cyst in the plane of the laminated membrane, suture of bile duct openings, and omentoplasty—achieved good local control of liver cysts. Further cysts, mainly in the retroperitoneal area, were identified with increasing frequency as time passed. The recurrence rate reached 22% by 30 months. Recurrence was not seen after that time. The longest period of follow‐up was 7 years. Not all recurrences required surgical treatment. Small asymptomatic cysts have been simply observed, and some shrink without further treatment. Multivariate analysis showed that the single main determinant of recurrence was evidence of previous cyst rupture before operation.