Background: The most common types of true epithelial exocrine pancreatic cystic neoplasms are serous cystic neoplasms (SCNs), mucinous cystic neoplasms (MCNs), intra-ductal papillary mucinous neoplasms (IPMNs), and solid pseudo-papillary neoplasms (SPPNs). Both open and laparoscopic pancreatic surgeries are major procedures with significant morbidity and mortality rates. This study aimed to determine the outcomes of laparoscopic pancreatic surgery in managing true exocrine epithelial pancreatic cystic neoplasms in terms of postoperative pancreatic fistula and recurrence rate and to identify associated risk factors. Methods: A prospective observational single-center study between June 2014 and January 2018 included 63 patients with true exocrine epithelial pancreatic cystic neoplasms. Distal pancreatectomy (Laparoscopic and open approaches) and pancreaticoduodenectomy (open approach) were performed according to the tumor site. Results: Pancreatic fistula developed in 10 cases (10/63, 16%), most commonly after surgical resection in MCNs (3 cases) and SPPNs (3 cases), while grade C (according to the International Study Group on Pancreatic Fistula, ISPGF) was more common in IPMNs (one case) and SPPNs (one case). Most cases of fistula (8 patients) followed distal pancreatectomy. Recurrence occurred in 6 cases (9.5%), mostly following resection of MCN (3 patients), and recurrence commonly occurred at the resection margin. Predictive factors of pancreatic fistula were symptoms (p = 0.006) and disease located at the pancreatic tail (p = 0.02) (RR 3.15, 95%CI 1.51-6.73). Predictors of recurrence were symptoms (p=0.02) (RR 1.9, 95%CI 1.45-2.45), location at the head (p=0.01) (RR 3.3, 95% CI 1.9-6.3), elevated CA19-9 (p=0.014) (RR 2.5, 95%CI 1.8-3.95) and pancreatic duct < 5 mm (p=0.000006) (RR 5.9 , 95%CI 2.8-12.3). The survival rate at 2.5 years was 96.7%, 100%, 88.9%, and 80% for SCNs, MCNs, IPMNs, and SPPNs, respectively. Conclusion: Surgical surgery to treat true exocrine epithelial pancreatic cystic neoplasms seems safe and effective. Pancreatic fistula and recurrence occurred in 16% and 9.5% of patients, respectively. Most cases followed MCN resection.