15 randomized controlled trials (n=1,596) comparing endoscopic carpal tunnel release (ECTR) with open carpal tunnel release (OCTR) for carpal tunnel syndrome were included in this meta-analysis. The purpose of this meta-analysis was to compare these two surgical approaches with respect to functional recovery within 3 months post-operation and safety. Pooled results indicated that although there were no significant differences between groups with regards to pain relief, paraesthesia relief, grip strength recovery within 3 months, or reoperation rate, ECTR yielded significantly favourable pinch strength recovery within 3 months and earlier return to work. ECTR also had significantly more reports of reversible nerve problems and significantly fewer wound complications when compared to OCTR.