Background: Some 5-10 per cent of patients with congenital 'solitary' liver cysts develop symptoms (pain, gastric outlet obstruction or jaundice), and require treatment. Methods: Ten consecutive patients with symptomatic non-parasitic liver cysts have been treated by laparoscopic fenestration. Results: There were no postoperative complications. During a median follow-up of 25.5 months with ultrasonographic examination there has been no recurrence of the cysts and the patients remain asymptomatic. Conclusion: The minimal access surgical approach by laparoscopic fenestration could become standard treatment for simple liver cysts.