Cystic echinococcosis (CE) is an endemic helminthic disease caused by infection with Echinococcus granulosus metacestodes. Although CE is endemic in the Balkan region, the exact epidemiology remains unknown. We conducted a case-series study with the aim of evaluating the correlation between seropositivity, socio-epidemiological data, pre-operative treatment with albendazole and viability of protoscolices in human hepatic hydatid cysts. Consecutive patients with hepatic CE underwent surgery to extract E. granulosis cysts. The viability of protoscolices was measured by their ability to absorb 0.1% eosin. Socio-epidemiological data were collected and serological testing was performed. In the present study, 38 patients (28 adults and 10 children) with hepatic CE were treated surgically. The scolex viability test was positive in 30/38 (79%) samples. All patients with non-viable cysts had seronegative results. The viability test was positive in 11/12 (91.6%) adult patients with pre-operative albendazole treatment and in 9/10 (90%) children. Statistically more patients were from an urban area compared with a rural area (65.8% vs. 15.7%). The increasing number of stray dogs shedding E. granulosus eggs in urban public areas in the Balkans might be the reason for the significant difference in the rate of infection between urban and rural areas in the present study. In addition, uncontrolled slaughtering of livestock, common in rural settlements, and feeding the infected viscera to dogs, favour the maintenance of the parasite cycle. We believe that the results of our study will encourage physicians, veterinarians and health authorities to initiate a programme to prevent and control CE in the Balkan region.