Alveolar hydatid disease is an uncommon parasitosis found in the northern hemisphere, caused by the larval stage of a tapeworm growing in the liver: Echinococcus multilocularis. It behaves like a malignant tumor, producing liver necrosis and invading the biliary tract, main vessels and surrounding structures.Review of the different therapeutic approaches in hepatic alveolar echinococcosis over 21 years in an epidemic area.The various surgical approaches (all types of hepatectomy, palliative surgical procedures and liver transplantation) were combined with medical, endoscopic and radiological interventional treatment. Recently, asymptomatic forms were more frequently encountered.The wide use of ultrasonography and specific serological tests have led to early diagnosis, allowing more curative hepatectomies.