Twenty-eight randomized controlled trials with 2549 carpal tunnel syndrome (CTS) patients were included in this meta-analysis comparing endoscopic carpal tunnel release (ECTR; n=1256) and open carpal tunnel release (OCTR; n=1293). The outcomes of interest included surgical time, grip strength, patient satisfaction, key pinch strength, return to work time, the Boston Carpal Tunnel Questionnaire (BCTQ) scores (symptom severity scale (BCTQ-S) and Functional Status (BCTQ-F)), the two-point discrimination (2PD) test, the Semmes-Weinstein (SW) monofilament test, patient satisfaction, and the incidence of post-surgical complications. Grip strength, key pinch strength, and the SW monofilament test were evaluated at 3 months post-operation, whereas BCTQ-S, BCTQ-F, and the 2PD test scores were measured at 3, 6, and >12 months post-operation. All remaining outcomes were measured at final follow-up. Pooled results revealed that BCTQ-S scores at 6 months (p<0.00001), overall patient satisfaction (p=0.0003), key pinch strength (p=0.003), time to return to work (p=0.04) and incidence of scar-related complications were statistically significantly in favour of ECTR. The pooled incidence of transient nerve injury was statistically significantly lower in the OCTR group compared to the ECTR group (p=0.01).