Aim of work: The purpose of this study is to compare the efficacy of double percutaneous aspiration and ethanol injection, with laparoscopic aspiration and  excision in patients with viable univesicular hydatid liver cysts. Patients & methods: The study was done over 30 patients divided randomly into 2 groups : Group I (n=15): Patients presented with a univesicular hydatid cyst and treated with ultrasonography - guided double per-cutaneous aspiration and ethanol injection. Group II (n=15): Patients presented with a univesicular hydatid cyst and treated with laparoscopic aspiration and excision. All patients were diagnosed primarily by ultrasonography then confirmed by CT scan and hematological screen on the basis of the presence of antibodies against Echinococcus granulosus using enzyme-linked immunosorbent assay (ELISA) at a titer of • 1:128. Patients with multivesicular hydatid liver cysts, recurrent cases, patients with chronic liver diseases and patients with non-parasitic liver cystic lesions are excluded from the study. Results: The mean operative time and hospital stay were significantly short in group I. There was no mortality in both groups. Intra-cystic bleeding was observed  in 1 (6.7%) patient in group I and was referred for surgery. Bile leak occurred in 2 (13.3%) patients in group II. Cavity infection with abscess formation occurred in 2 (14.3%) patients in group I. No major complications occurred in both groups apart from minimal pleural effusion in 1 (6.7%) patient in group II. No local recurrence was observed in follow up of group II patients compared to 2 (14.3%) cases of recurrence in group I. The cysts disappeared in 9 (64.3%) patients in group I with reconstruction of liver parenchyma while group II showed cyst disappearance in all (100%) patients of the group. Conclusion: Laparoscopic management of hydatid hepatic cysts (HHC) seems effective and safe, with low morbidity and recurrence rates. Double percutaneous aspiration and ethanol injection showed high efficacy on unilocular hydatid hepatic cysts in terms of disappearance of the cysts and few side effects and can be considered a first line in treatment of unilocular non-complicated hydatid liver cyst.