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Total cystectomy is a challenging procedure in patients with complicated liver hydatid cysts (HCs). This study aimed to evaluate the feasibility and safety of laparoscopic total cystectomy in patients with complicated liver HCs.Prospectively collected clinical data of 50 consecutive patients, who underwent laparoscopic procedures for complicated liver HCs between January 2017 and January 2019, were retrospectively analyzed. One hundred patients who underwent open procedures were compared with the laparoscopic group in terms of perioperative outcomes during the 1-year follow-up period.Conversion to open surgery occurred in 1 (2%) case. The number of single and multiple lesions and the size of HCs were similar between the 2 groups (P>0.05). Sixty-six percent of patients underwent total cystectomy, 10% subtotal cystectomy, and 24% hepatectomy in the laparoscopic group (P>0.05). Decompression and hepatic inflow occlusion were performed in high-risk cases. No differences were noted in average blood loss volume, and transfusion rate between the 2 groups. Postoperative recovery in the laparoscopic group was significantly shorter than that in the open group. There was no difference in the incidence of postoperative complications between the laparoscopic and open groups. No recurrence or death was observed in either group during this period.Laparoscopic total cystectomy was a curative and safe surgical approach to the treatment of complicated HC with favorable mid-term outcomes. Subtotal cystectomy combined with decompression is the preferred option for patients with high surgical risk(s). However, long-term outcomes need to be validated in prospective studies with larger sample sizes and prolonged follow-up.