Objective To investigate the clinical characteristics and laparoscopic strategy of female inguinal hernia with cyst of round ligament of uterus. Methods The clinical data of 63 female patients of inguinal hernia with cyst of round ligament of uterus as cyst group admitted to our Department of Surgery, from January 2001 to December 2018 were analyzed retrospectively. The patients in cyst group were compared to contemporaneous 412 female patients of inguinal hernia without cyst as non-cyst group. Results The majority female patients of inguinal hernia with cyst of round ligament of uterus were youth with 87.3% of indirect hernia. There were 93.7% transabdominal preperitoneal(TAPP) repaire more than 6.3% total extraperitoneal repaire. The preservation rate of round ligament of uterus was 34.9% in cyst group and 46.4% in non-cyst group without significant difference statistically (P=0.086). However, the preservation rate of round li-gament of uterine of patients younger than 45 years in cyst group (47.1%) was less than that in non-cyst group (89.1%) and the difference was statistically significant (P<0.001). No significant difference was found between cyst group and non-cyst group in operation time, hospital stay, visual analogue pain scale on the first postoperative day, postoperative seroma, urinary retention, recurrence, and the amount of patients recovery to unrestricted activities within 2 weeks (P>0.05). Conclusions Female inguinal hernia with cyst of round ligament of uterus ws more seen in young women. TAPP could be used for exploration and definite diagnosis. Most cyst of round ligament of uterus can be resected during herniorrhaphy simultaneously. The difficulty in retaining round ligament of uterus increased when the cyst is present.