Echinococcosis is a parasitic infestation with high prevalence in Iraq. Surgical treatment remains the standard gold method for treating this disease. The selection of surgical approach depends on the general condition of the patient and characters of the cyst, e.g., size, location, number of cysts, intraoperative findings, and complications such as adhesion, bile leakage, and bleeding. Our study aimed (1) to summarize the most common surgical approaches for treating liver hydatid cyst (HC) in our locality, and (2) to highlight common intraoperative and postoperative complications and the duration of hospital stay. We analyzed the clinical data of 42 patients operated for liver HC. We found that the highest incidence rate of HC was anatomically in the right hepatic lobe with or without synchronous cysts in other organs. The most frequent type of surgery was partial pericystectomy with external tube drainage (ETD) or simple endocystectomy with omentoplasty and ETD. The most important intraoperative finding was cystic-biliary communication. The majority of patients had uneventful postoperative recovery. There is no standardized surgical procedure for hepatic HC. The surgical technique should be modified according to the cyst size, anatomic location of cyst/cysts, number of cysts, cystobiliary communications, cystic infection, and the presence of extrahepatic hydatid cyst or cysts. The surgeon’s experience plays a vital role in selecting the surgical technique for hepatic hydatid cystectomy.