ObjectiveTo evaluate and discuss the various surgical methods for hepatic echinococcosis. MethodsFour hundred and two patients with hepatic echinococcosis were treated in West China Hospital of Sichuan University from 2009 to 2014 and 271 of them were undergone surgical treatment. The cystic echinococcosis was in 195 patients, including 80 cases performed classic endocystectomy or subtotal cystectomy, 109 performed total cystectomy or hepatectomy, 6 cases performed palliative surgery. The alveolar echinococcosis was in 76 patients, including 7 cases performed palliative surgery, 54 cases performed hepatectomy, 12 cases performed liver allotransplantation, and 3 cases performed liver autotransplantation. Results①The draining time, the rate of postoperative complications, and the recurrence was (18.6±2.7) d, 21.2% (17/80), and 15.0%(12/80) respectively in the cases of cystic echinococcosis underwent classic endocystectomy or subtotal cystectomy, which were significantly higher than those cases of cystic echinococcosis underwent total cystectomy or hepatectomy〔(5.4±0.6) d, 7.3% (8/109), and 0.9% (1/109), respectively, P < 0.05〕.②The draining time and the recurrence was (5.9±0.7) d and 1.8% (1/54) respectively in the cases of alveolar echinococcosis underwent hepatectomy, which were significantly lower than those in the cases of alveolar echinococcosis took palliative surgery〔(9.7±1.4) d and 57.1% (4/7), respectively, P < 0.01〕. The 12 patients underwent liver transplantation were complete rehabilitation, while the rest 3 were death. Conclusions①Total cystectomy or hepatectomy should be the first choice for cystic echinococcosis; Palliative treatment could improve the symptoms of unresectable patients with cystic echinococcosis.②Hepatectomy should be the first choice for alveolar echinococcosis, palliative surgery could only be used to alleviate symptoms and physical signs, delay the progression of this disease.③Liver transplantation might be an alternative for advanced hepatic echinococcosis.