23 randomized controlled trials (2284 patients) comparing open versus endoscopic techniques for carpal tunnel release in patients with carpal tunnel syndrome were included in this systematic review and meta-analysis. A subgroup analysis was also conducted on single- versus dual-portal endoscopic treatment. The primary outcomes of interest included complication and reoperation rates. Secondary outcomes included operative time, the incidence of scar tenderness and pillar pain, normalized satisfaction scale, the incidence of complete or near complete symptom relief, Boston Carpal Tunnel Questionnaire (BCTQ) symptom and function, and time to return to work. All outcomes were similar between the two groups except for time to return to work and incidence of scar tenderness (dual-portal vs open) which all favored the endoscopic group. The incidence of nerve injury was significantly lower in the open-technique group. Overall, the endoscopic group can provide advantages such as less pain and shorter time to recovery compared to the open group for carpal tunnel syndrome.