Objective To explore the perioperative complications in laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy for choledochal cyst in children.Methods Retrospective analyses were performed for 78 cases of laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy choledochal cyst from March 2012 to November 2013.There were 9 males and 69 females.And the types were cystic (n =61) and fusiform (n =17).Results Laparoscopic procedure was completed successfully for all cases.The average operative duration was 3.5 (2.5-5.5) hours.Intraoperative complication occurred in 3 patients.There were right hepatic duct injury (n =1),left hepatic duct separation (n =1) and bleeding of variation cholecystic artery (n =1).All three cases were treated timely during surgery without adverse consequences.Postoperative complications of 8 cases included hemorrhage (n=2),bile leakage (n =2),anastomotic stenosis (n =1),postoperative pancreatitis (n =1) and gallbladder fossa or subphrenic encapsulated fluid (n =2).Exploratory laparotomy was performed for hemorrhage (n =1) and laparoscopic hepatoenterostomy for anastomosis stricture (n =1).One case of bile leakage was cured after 3 weeks of peritoneal drainage while another case recovered completely after puncture drainage for encapsulated fluid.Postoperative pancreatitis was cured after jejunal feeding for 4 weeks.During a follow-up period of 3-22 months,reexaminations of liver function and ultrasound were made.Three cases of intrahepatic calcification were found with normal liver function.Conclusions Laparoscopic total cyst excision with Roux-en-Y hepatoenterostomy for choledochal cyst is a complex and high-risk procedure.Precise intraoperative handling may reduce intraoperative and postoperative complications.