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Laparoscopic fenestration is the treatment of choice for symptomatic liver cysts. Despite the benefits of minimally invasive surgery, there is limited data on long-term outcomes after laparoscopic fenestration, in terms of symptom recurrence and quality of life. The purpose of this study was to evaluate long-term patient-reported outcomes and satisfaction following this procedure.All patients who underwent laparoscopic liver cyst fenestration in a single center between 2001 and 2012 were identified from a prospectively maintained database. Long-term patient-reported outcomes including symptom relief and quality of life were prospectively evaluated by a structured telephone interview.A total of 98 patients underwent laparoscopic liver cyst fenestration. The median follow-up was 62 months (range, 22 to 173 mo). Follow-up data was available in 48 patients. Four patients developed radiologically confirmed evidence of recurrence with 3 undergoing further surgery. No mortality was reported in the series. Four complications occurred and the median postoperative length of hospital stay was 2 days (range, 1 to 7 d). Thirty-nine patients received immediate symptomatic relief with 98% reporting long-term satisfaction.Laparoscopic liver cyst fenestration is associated with low morbidity and long-term alleviation of symptoms. This should be considered the treatment modality of choice in managing patients with nonparasitic cysts.