In spite of recent progress, treatment for liver echinococcal cysts is still far from satisfying. In recent years, percutaneous drainage has been increasingly used for this purpose and it has been shown to be an effective alternative to surgery and chemotherapy alone. This technique is known as PAIR, from Puncture, Aspiration, Injection (of a scolecidal agent), Reaspiration: here we present our experience and the state of the art of PAIR. Patients from Italy and Turkana (Kenya), harbouring 233 Gharbi type I, II and III echinococcal cysts were successfully treated with PAIR: it was performed according to protocols established at the Division of Infectious and Tropical Diseases, IRCCS--Policlinico S. Matteo, University of Pavia. In Italy, one relapse was recorded, four years after the procedure; the patient was treated again with PAIR; no cases of anaphylactic shock or peritoneal dissemination were observed in a follow-up of 10 years; only 10 minor complications (biliary fistula, urticarioid reaction, abscessualization of the cyst, anaphylactoid reactions) were reported. Long-term results indicate that in Gharbi type I, II and III echinococcal cysts, and in developing countries, in particular, PAIR is a first choice method for the treatment of abdominal localizations of this disease.