Objective To compare the efficacy of open and laparoscopic fenestration for congenital liver cysts.Methods We analyzed the clinical data of 71 cases with congenital liver cysts,who were treated at our department from June 2000 to June 2006. Among the cases,34 received open fenestration (laparotomy group),and the other 37 underwent laparoscopic fenestration (laparoscopy group). The operation time,perioperative blood loss,postoperative hospital stay,and cost of hospitalization were compared between the two groups. Results The laparoscopy group had significantly shorter operation time [(45?15) min vs (75?15) min,t=-7.016,P=0.000],fewer perioperative blood loss [(24?8) ml vs (50?12) ml,t=-10.823,P=0.000],and shorter postoperative hospital stay [(7.6?1.3) d vs (12.2?2.1) d,t=-11.196,P=0.000] than those in the laparotomy group; whereas no significant difference was observed in the cost of hospitalization between the two groups [(10210?1090) RMB vs (10180?1130) RMB,t=0.114,P=0.910]. None of the patients in both the groups showed bile leakage or massive hemorrhage after the operation. Among the cases,62 patients (62/71,87.3%; 32 in laparoscopy group,and 30 in laparotomy group) received a mean of 25-month follow-up (ranged from 6 to 48 months),during the period,one case of recurrent cyst was detected by B-ultrasonography in laparotomy group. The rate of recurrence was 1.6% (1/62). Conclusions Laparoscopic fenestration can be a replacement of open fenestration owing to its advantages in short operation time and postoperative hospital stay and less hemorrhage and quicker recovery.