Hepatic cystic echinococcosis (HCE) is an emerging disease in central Asia, particularly in Pakistan, due to the migration of infected people. Medical records of patients with HCE admitted between 1995 and 2006 to a tertiary care hospital were reviewed. A total of 106 patients were admitted with a mean age of 34±17 years; 60 (56.6%) were men, 72 (67.9%) were residing in rural areas of Pakistan and 21 (19.8%) were Afghan refugees. Twenty-seven (25.4%) had extra hepatic cysts and liver cysts. All patients received albendazole. Percutaneous aspiration, instillation and reaspirarion was done in 14 (13.2%) patients and 71 (66.9%) underwent surgery. Three (2.8%) died and 14 (13.2%) had morbidity. This is one of the largest series of HCE reported from Pakistan. HCE is mostly prevalent in rural areas and among Afghan refugees with low mortality and recurrence, but with significant morbidity.